Construction of risk factors for autologous arteriovenous fistula failure in 120 patients with chronic kidney disease stage 4 to 5 maintenance hemodialysis and prevention strategies / 中国医师进修杂志

ABSTRACT

Objective:To explore the risk factors and prevention strategies for autologous arteriovenous fistula failure in 120 maintenance hemodialysis (MHD) patients, and build a regression model.Methods:The clinical data of 120 patients received MHD treatment in Anji County People′s Hospital from January 2020 to February 2022 were retrospectively analyzed, and the selected patients were divided into the failure group (25 cases) and the patency group (95 cases) according to whether they had autologous arteriovenous fistula failure. The clinical data of the two groups were compared. Multivariate Logistic regression analysis method was used to analyze the risk factors of autologous arteriovenous fistula failure in MHD patients. And a Logistic regression model was established to analyze the predictive value.Results:The proportions of women, diabetes and temporary catheter dialysis patients in the failure group were higher than those in the patency group: 56.00% (14/25) vs. 33.68% (32/95), 44.00% (11/25) vs. 13.68% (13/95), 92.00% (23/25) vs. 65.26% (62/95); the time of catheterization, plasma parathyroid hormone, serum albumin (Alb), D-Dimer (D-D), fibrinogen (FIB) and phosphorus were higher than those in the patency group: (47.87 ± 18.43) d vs. (39.65 ± 16.58) d, (439.76 ± 23.45) ng/L vs. (354.54 ± 31.26) ng/L, (43.43 ± 2.54) g/L vs. (39.65 ± 2.31) g/L, (1.13 ± 0.32) mg/L vs. (0.23 ± 0.07) mg/L, (5.64 ± 2.14) g/L vs. (2.76 ± 0.76) g/L, (3.54 ± 1.02) mmol/L vs. (0.76 ± 0.05) mmol/L( P<0.05). The results of multivariate Logistic regression analysis showed that female, concomitant diabetes, temporary catheter dialysis, and high level of serum phosphorus were independent risk factors for autologous arteriovenous fistula failure in MHD patients ( OR = 2.654, 3.077, 3.721, 2.646; P<0.05). Regression equation model was: logit( P) = -12.763 + sex × 0.976 + diabetes × 1.124 + temporary catheter dialysis × 1.314 + level of blood phosphorus × 0.973. When Logistic ( P) > 18.542, the area under the curve (AUC) value for autologous arteriovenous fistula failure prediction in this model was 0.882 (95% CI from 0.811 to 0.934), and with sensitivity of 80.00%, and specificity of 83.16%. Conclusions:Female gender, diabetes mellitus, temporary catheter dialysis, and high blood phosphorus level were independent risk factors for autologous arteriovenous fistula failure in patients with MHD. The model had a good predictive value for failure of autologous arteriovenous fistula in patients with MHD. Corresponding treatment and intervention measures could be used for patients with the above conditions in order to reduce the risk of autologous arteriovenous fistula failure and improve the treatment effect.