Analysis Of Factors Influencing Failure Of Arteriovenous Fistula And Aneurysmal Dilatation In Maintenance Hemodialysis Patients

Part Ⅰ Analysis of influencing factors of arteriovenous fistula failure in non-diabetic maintenance hemodialysis patientsObjective:To investigate the failure of arteriovenous fistula(AVF)in non-diabetic maintenance hemodialysis patients and to explore the related factors affecting AVF failure.Methods:Ninety-two non-diabetic patients who received maintenance hemodialysis(MHD)treatment in the Hemodialysis Center of the Second Hospital of Shanxi Medical University from January 2021 to June 2021 and had complete clinical data were studied,and the data were collected by consulting the hospital medical record system and outpatient hemodialysis information system,and the general data,dialysis data,laboratory data,and vascular ultrasound data of the patients were retrospectively analyzed.According to the diagnostic criteria of AVF failure,the patients were divided into failure group and non-failure group,and the differences in various clinical data between the two groups were compared.Multivariate Cox proportional hazards regression model was used to analyze the influencing factors of the service life of arteriovenous fistula(AVF),and Kaplan-Meier method was used to draw the survival curve.Results:A total of 92 diabetic MHD patients were included in this study,69(75%)in the n-failure group and 23(25%)in the failure group.Diastolic blood pressure,cephalic vein diameter,radial artery diameter,and serum albumin were lower,while serum phosphorus,calcium-phosphorus product,C-reactive protein,and MIAS incidence were higher in the failure group compared with the AVF non-failure group,and the differences were statistically significant(all P<0.05).Multivariate Cox regression analysis showed that higher diastolic blood pressure,higher serum albumin,and larger radial artery diameter were protective factors for AVF failure,while MIAS in MHD patients was a risk factor for AVF failure.Kaplan-Meier survival curve analysis showed that the AVF service life of MHD patients with hypoalbuminemia was significantly longer than that of non-diabetic MHD patients without hypoalbuminemia(log-rankχ~2=27.776,P<0.001).Conclusion:Higher diastolic blood pressure is a protective factor for AVF failure in non-di abetic MHD patients,while hypoalbuminemia and MIAS are risk factors for AVF f ailure in non-diabetic MHD patients.Therefore,for non-diabetic MHD patients,reas onable management of diastolic blood pressure,improvement of nutritional status an d inflammatory status,and reduction of atherosclerotic complications can protect fist ula function and prolong the service life of the fistula.Smaller radial artery diamet er predisposes to fistula failure,so preoperative assessment of vascular conditions c an provide more appropriate vascular access options for patients.Part Ⅱ Analysis of influencing factors of aneurysmal dilatation of arteriovenous fistula in maintenance hemodialysis patientsObjective:To investigate the incidence of aneurysmal dilatation of arteriovenous fistula(AVF)in maintenance hemodialysis patients and to explore the related factors affecting the occurrence of aneurysmal dilatation.Methods:A total of 141 patients who received maintenance hemodialysis(MHD)treatment in the Hemodialysis Center of the Second Hospital of Shanxi Medical University from January 2021 to June 2021 and had complete clinical data were selected as the study subjects.The data were collected by consulting the hospital medical record system and outpatient hemodialysis information system.The patients were divided into aneurysmal dilatation group and non-aneurysmal dilatation group according to the consensus aneurysmal dilatation criteria of vascular access experts in China.The differences in the general clinical data,vascular ultrasound data and laboratory parameters between the two groups were compared.Binary logistic regression model was used to analyze the influencing factors of AVF aneurysmal dilatation in MHD patients.Results:(1)Among the MHD patients in our hospital,35 had AVF aneurysmal dilatation and the incidence of AVF aneurysmal dilatation was 24.82%.(2)the dialysis age,systolic blood pressure,diastolic blood pressure,cephalic vein diameter,and brachial artery blood flow of the aneurysmal dilatation group were higher than those of the non-aneurysmal dilatation group,while serum albumin and BMI was lower than that of the non-aneurysmal dilatation group,and the differences were statistically significant(P < 0.05).(3)with AVF aneurysmal dilatation in patients as the dependent variable,the results of multivariate logistic regression analysis showed that higher dialysis age and higher brachial artery blood flow were risk factors for AVF aneurysmal dilatation,while higher serum albumin was a protective factor for AVF aneurysmal dilatation.Conclusion:The incidence of AVF aneurysmal dilatation in MHD patients was 24.82%.Improving nutritional status,controlling fistula blood flow during surgery,and avoiding excessive blood flow while ensuring adequate blood flow can reduce and delay the occurrence of AVF aneurysmal dilatation.