High pulse pressure predicts primary arteriovenous fistula failure within 1 year.

IF 1.2 4区医学 Q3 NURSING Revista da Escola de Enfermagem da U S P Pub Date : 2023-11-01 Epub Date: 2022-04-08 DOI:10.1177/11297298211054797

Chung-Cheng Wu, Hao-Chien Hung, Tsung-Chi Kao, Chun-Hsien Hsin, Sheng-Yueh Yu, Hung-Chang Hsieh, Po-Jen Ko

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引用次数: 1

Abstract

Background: The arteriovenous fistula is the preferred access route for hemodialysis, although its high primary failure rate remains a clinical challenge. Multiple studies have attempted to determine the risk factors for primary arteriovenous fistula failure; however, none have identified pulse pressure as a potential predictive marker. High pulse pressure is a surrogate poor arterial compliance endpoint and leads to inferior cardiovascular outcomes. Our aim was to determine whether elevated pulse pressure indicates poor arteriovenous fistula maturation.

Methods: We retrospectively reviewed 274 patients who underwent an arteriovenous fistula index operation between September 1, 2018 and May 31, 2019. Demographic, clinical data, and operative parameters were collected and analyzed. The maximum follow-up period was 365 days. Arteriovenous fistula failure was defined as the inability to achieve functional use during the follow-up period. We identified risk factors for arteriovenous fistula failure by performing a multivariate logistic regression analysis using backward elimination procedures.

Results: A total of 274 patients were included in the study. The patients' average age was 61.3 ± 14.0 years, approximately half of the patients (n = 161, 58.8%) were male, and the majority had hypertension. At the end of the follow-up period, 68 (24.8%) had arteriovenous fistula failure. The proportion of patients with pulse pressure values of >60 mmHg was significantly higher in the failure group than in the maturation group (66.0% vs 80.9%; p = 0.021). A PP value of >60 mmHg (odds ratio = 2.25; 95% confidence interval = 1.14-4.42; p = 0.019) and coronary artery disease or myocardial infarction (odds ratio = 1.97; 95% confidence interval = 1.01-3.84; p = 0.045) were found to be independent risk factors for primary arteriovenous fistula failure.

Conclusions: High pulse pressure is an independent risk factor for primary arteriovenous fistula failure.

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高脉压可预测原发性动静脉内瘘一年内的失败。

背景：动静脉内瘘是血液透析的首选通路，但其原发性失败率较高，这仍是一项临床挑战。多项研究试图确定动静脉内瘘原发性失败的风险因素，但没有一项研究确定脉压是潜在的预测指标。高脉压是动脉顺应性差的替代终点，会导致心血管不良后果。我们的目的是确定脉压升高是否预示着动静脉瘘成熟不良：我们回顾性审查了 2018 年 9 月 1 日至 2019 年 5 月 31 日期间接受动静脉瘘指数手术的 274 名患者。收集并分析了人口统计学、临床数据和手术参数。随访时间最长为 365 天。动静脉内瘘失败的定义是在随访期间无法实现功能性使用。我们采用反向排除法进行了多变量逻辑回归分析，确定了动静脉瘘失败的风险因素：研究共纳入 274 名患者。患者的平均年龄为（61.3 ± 14.0）岁，约半数患者（n = 161，58.8%）为男性，大多数患者患有高血压。在随访期结束时，68 名患者（24.8%）的动静脉内瘘已经失效。失败组中脉压值大于 60 mmHg 的患者比例明显高于成熟组（66.0% vs 80.9%；P = 0.021）。脉压值>60 mmHg（几率比=2.25；95%置信区间=1.14-4.42；p=0.019）和冠状动脉疾病或心肌梗死（几率比=1.97；95%置信区间=1.01-3.84；p=0.045）是原发性动静脉内瘘失败的独立风险因素：结论：高脉压是原发性动静脉内瘘失败的独立危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista da Escola de Enfermagem da U S P 医学-护理

CiteScore

1.70

自引率

11.10%

发文量

254

审稿时长

3-8 weeks

期刊介绍： The University of São Paulo Nursing School Journal (Revista da Escola de Enfermagem da USP, REEUSP) is a bimonthly periodical revised by fellow nurses, which has the objective of publishing empirical or theoretical articles that represent a significant advance for the professional practice or for the fundaments of Nursing Mission: to stimulate knowledge production and dissemination in Nursing and related areas, focusing on international interlocution to advance Nursing science. Areas of Interest: Nursing and Health Its abbreviated title is Rev Esc Enferm USP, which should be used in bibliographies, footnotes and bibliographical references and strips.