Factors associated with dysfunction of autogenous arteriovenous fistula in patients with secondary hyperparathyroidism after parathyroidectomy.

IF 3 3区 医学 Q1 UROLOGY & NEPHROLOGY Renal Failure Pub Date : 2024-12-01 Epub Date: 2024-10-16 DOI:10.1080/0886022X.2024.2402515
Boxi Chen, Qiying Fang, Yiming Tao, Siqi Peng, Shuting Deng, Ye Yuan, Nan Jiang, Sichun Wen, Bohou Li, Qiong Wu, Zewen Zhao, Pingjiang Ge, Sijia Li, Ting Lin, Zhonglin Feng, Feng Wen, Lei Fu, Zhuo Li, Jia Wen, Renwei Huang, Chaosheng He, Wenjian Wang, Guibao Ke, Lixia Xu, Shuangxin Liu, Jianchao Ma
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Abstract

Background: Secondary hyperparathyroidism (SHPT) is a prevalent chronic complication in patients undergoing hemodialysis. Parathyroidectomy (PTX) is crucial for reducing mortality and improving the prognosis in the treatment of refractory hyperparathyroidism. However, it is often associated with a number of postoperative complications such as postoperative hypotension, hyperkalemia, and hungry bone syndrome. A previous study demonstrated that low blood pressure influences the patency of autogenous arteriovenous fistulas (AVF). Few studies have examined AVF dysfunction following PTX. This study aimed to identify and describe the risk variables associated with AVF dysfunction after PTX.

Methods: Cases of AVF dysfunction after PTX between 2015 and 2021 were studied. Four controls were identified for each patient and were matched for sex and age. Biochemical parameters and blood pressure of the patients before and after PTX were recorded. Risk factors for AVF dysfunction after PTX were identified using conditional logistic regression analysis.

Results: Sixteen patients and 64 controls were included in this study. Baseline demographic and laboratory data were compared. Patients in the AVF dysfunction group had lower levels of postoperative calcium than the controls. After surgery, calcium levels decreased more in patients with AVF dysfunction than in the control group. The decrease in systolic blood pressure (ΔSBP) after PTX was greater in the AVF dysfunction group than that in the control group. For each 1 mmHg increment in ΔSBP, the risk of AVF dysfunction after surgery increased by 11.6% (OR = 1.116, 95% CI, 1.005-1.239, p = .040). The likelihood of developing AVF dysfunction after surgery was twelvefold higher in diabetic patients than in non-diabetic patients (OR = 12.506, 95% CI, 1.113-140.492, p = .041). Among patients with ΔSBP > 5.8 mmHg after PTX, the AVF failure rate was significantly greater in patients with diabetes than in those without diabetes. Patients with a history of AVF failure had a nine-fold higher risk of developing AVF dysfunction (OR = 9.143, 95% CI, 1.151-72.627, p = .036). Serum albumin, hemoglobin, ΔiPTH, and age were not independent predictors of AVF dysfunction. The cutoff value for SBP was 5.8 mmHg, as determined by the Youden index of the receiver operating characteristic curve.

Conclusion: Decreased systolic blood pressure (ΔSBP) after PTX, diabetes, and AVF failure history were risk factors for AVF dysfunction following PTX in patients with SHPT. Diabetes patients with ΔSBP > 5.8 mmHg were more prone to AVF dysfunction after PTX.

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甲状旁腺切除术后继发性甲状旁腺功能亢进症患者自体动静脉瘘功能障碍的相关因素
背景:继发性甲状旁腺功能亢进症(SHPT继发性甲状旁腺功能亢进症(SHPT)是血液透析患者普遍存在的一种慢性并发症。在治疗难治性甲状旁腺功能亢进症时,甲状旁腺切除术(PTX)对于降低死亡率和改善预后至关重要。然而,PTX术后往往会出现一系列并发症,如术后低血压、高钾血症和饿骨综合征。之前的一项研究表明,低血压会影响自体动静脉瘘(AVF)的通畅性。很少有研究对 PTX 术后动静脉瘘功能障碍进行研究。本研究旨在确定和描述与 PTX 后动静脉瘘功能障碍相关的风险变量:方法:研究了 2015 年至 2021 年间 PTX 术后出现动静脉瘘功能障碍的病例。每名患者确定四名对照组,并进行性别和年龄匹配。记录PTX前后患者的生化指标和血压。通过条件逻辑回归分析确定了 PTX 后动静脉瘘功能障碍的风险因素:本研究共纳入 16 名患者和 64 名对照组。比较了基线人口统计学和实验室数据。动静脉瘘功能障碍组患者术后血钙水平低于对照组。术后,动静脉瓣膜功能障碍患者的血钙水平下降幅度大于对照组。PTX 术后,动静脉瓣膜功能障碍组收缩压(ΔSBP)的下降幅度大于对照组。ΔSBP 每增加 1 mmHg,术后发生动静脉瓣膜功能障碍的风险增加 11.6%(OR = 1.116,95% CI,1.005-1.239,p = .040)。糖尿病患者术后发生动静脉瓣膜功能障碍的可能性是非糖尿病患者的 12 倍(OR = 12.506,95% CI,1.113-140.492,p = .041)。在 PTX 后ΔSBP > 5.8 mmHg 的患者中,糖尿病患者的动静脉瓣膜失败率明显高于非糖尿病患者。有动静脉瘘失败史的患者发生动静脉瘘功能障碍的风险高出九倍(OR = 9.143,95% CI,1.151-72.627,p = .036)。血清白蛋白、血红蛋白、ΔiPTH 和年龄不是 AVF 功能障碍的独立预测因素。根据接收者操作特征曲线的尤登指数,SBP 的临界值为 5.8 mmHg:结论:PTX 后收缩压下降(ΔSBP)、糖尿病和 AVF 衰竭史是 SHPT 患者 PTX 后 AVF 功能障碍的危险因素。ΔSBP>5.8 mmHg的糖尿病患者在 PTX 后更容易出现动静脉瓣膜功能障碍。
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来源期刊
Renal Failure
Renal Failure 医学-泌尿学与肾脏学
CiteScore
3.90
自引率
13.30%
发文量
374
审稿时长
1 months
期刊介绍: Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
期刊最新文献
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