维持性血液透析患者血管通路满意度与全因死亡的相关性研究-现代医学

维持性血液透析患者血管通路满意度与全因死亡的相关性研究

单位：东南大学附属中大医院血液净化中心, 江苏南京 210009

分类号：R459.5

出版年·卷·期（页码）：2025·53·第一期（17-21）

摘要：

目的: 探讨维持性血液透析(MHD)患者血管通路(VA)满意度与全因死亡率之间的关系。方法: 本研究为观察性前瞻性研究，选取两个透析中心229例MHD患者，每6个月对患者生活质量和血管通路满意度进行评估，共随访30个月。使用血管通路问卷(VAQ)评估患者的VA满意度。运用二元Logistic回归分析评估MHD患者全因死亡率的影响因素。结果: 在30个月的随访期间，35例患者退出，其中31例死亡，4例在肾移植后停止MHD治疗。回归分析表明，患者年龄、VAQ总分、社会功能得分、透析相关并发症得分、SF-36总分以及心理健康总分(MCS)是影响MHD患者全因死亡率的因素。基线VAQ评分≥7分的MHD患者随访时生存质量显著下降，且生存分析结果表明，累计生存率明显低于VAQ评分<7分的患者。结论: VA满意度与MHD患者的全因死亡率显著相关，表明VA的选择需要关注患者对通路的满意度及意愿。

Objective: To explore the relationship between vascular access(VA) satisfaction and all-cause mortality in maintenance hemodialysis(MHD) patients. Methods: 229 MHD patients in two dialysis centers were enrolled in this observational prospective study，and patients' quality of life and vascular access satisfaction were evaluated every 6 months, with a total follow-up of 30 months，VA satisfaction was assessed using the Vascular Access questionnaire(VAQ). Multiple logistic regression analysis was used to evaluate the influencing factors of all-cause mortality. Results: During the 30-month follow-up, 35 patients dropped out, of whom 31 died and 4 stopped MHD treatment after renal transplantation. Multivariable analyses showed that the age, VAQ total score, social functioning score, dialysis-related complication score of the VAQ, and the total score of mental component summary(MCS) and SF-36 were factors influencing all-cause mortality in MHD patients. The Health-Related Quality of Life(HRQoL)was significantly higher in the MHD patients with VAQ scores<7 at baseline than that in patients with VAQ scores≥7. The Kaplan-Meier curve further showed that the cumulative survival probability was significantly higher in MHD patients with VAQ scores<7 at baseline than that in patients with VAQ scores ≥7. Conclusion: VA satisfaction is significantly associated with all-cause mortality in MHD patients, suggesting that a holistic approach is required for VA choice.

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