Abstract
Objective To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients. Methods A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed. Results The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis (P < 0.05). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis (P < 0.05). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ2 test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups (P > 0.05). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group (P < 0.05). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection. Conclusion If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.
Highlights
Hemodialysis is a vital treatment for all uremic patients to survive
Establishment of vascular accesses: patients in both groups were placed in a supine position, and after the arteriovenous vascular access was confirmed, lidocaine was used for local anesthesia; those in the Cuff tunnel conduit (CTC) group were established with cuff tunnel catheter, model 13.6 F ∗ 36 cm (Joka Kathetertechnik, Hechingen, Germany); and those in the AVF group were established with autologous arteriovenous fistula
AVF has the advantages of stable blood flow, infection of internal fistula, and low incidence of embolism, but it cannot be used in emergency hemodialysis and can only be used after the internal fistula matures [10, 18]. us, these two methods are used as complementary schemes to each other in clinical practice
Summary
Hemodialysis is a vital treatment for all uremic patients to survive For those who need dialysis for a long time, establishing and maintaining permanent vascular accesses with good function is a crucial condition for prolonging their survival [1, 2]. A stable and reliable vascular access is the basic guarantee for smooth hemodialysis To achieve this goal, and to improve the dialysis effect and quality of life of patients, it is necessary to establish scientific vascular accesses according to patients’ condition [3, 4]. Compared with CTC, AVF has the advantages such as long service life, stable blood flow, and low Evidence-Based Complementary and Alternative Medicine incidence of internal fistula infection and thrombosis [10, 11]. It becomes extremely difficult to reconstruct internal fistula [12]
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