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Clinical kidney journal. 2019 May 11;13(1):116-122. doi: 10.1093/ckj/sfz048 Q13.92024

Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial

来自AURORA试验的血液透析患者的动脉静脉瘘血栓与全因和心血管死亡率增加有关 翻译改进

Sophie Girerd  1  2  3, Nicolas Girerd  2  3, Luc Frimat  1  3, Hallvard Holdaas  4, Alan G Jardine  5, Roland E Schmieder  6, Bengt Fellström  7, Nicla Settembre  8, Sergei Malikov  8, Patrick Rossignol  2  3, Faiez Zannad  2  3

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作者单位

  • 1 Department of Nephrology, University Hospital, Nancy, France.
  • 2 INSERM, Centre d'Investigation Clinique Plurithématique, University Hospital, Lorraine University, Nancy, France.
  • 3 F-CRIN INI-CRCT, Nancy, France.
  • 4 Medical Department, Rikshospitalet, University of Oslo, Oslo, Norway.
  • 5 Renal Research Group, British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
  • 6 Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
  • 7 Department of Nephrology, University Hospital, Uppsala, Sweden.
  • 8 Department of Vascular Surgery, University Hospital, Nancy, France.

    • DOI: 10.1093/ckj/sfz048 PMID: 32082562

    摘要 Ai翻译

    Background: The impact of arteriovenous fistula (AVF) or graft (AVG) thrombosis on mortality has been sparsely studied. This study investigated the association between AVF/AVG thrombosis and all-cause and cardiovascular mortality.

    Methods: The data from 2439 patients with AVF or AVG undergoing maintenance haemodialysis (HD) included in the A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events trial (AURORA) were analysed using a time-dependent Cox model. The incidence of vascular access (VA) thrombosis was a pre-specified secondary outcome.

    Results: During follow-up, 278 AVF and 94 AVG thromboses were documented. VA was restored at 22 ± 64 days after thrombosis (27 patients had no restoration with subsequent permanent central catheter). In multivariable survival analysis adjusted for potential confounders, the occurrence of AVF/AVG thrombosis was associated with increased early and late all-cause mortality, with a more pronounced association with early all-cause mortality {hazard ratio [HR] < 90 days 2.70 [95% confidence interval (CI) 1.83-3.97], P < 0.001; HR > 90 days 1.47 [1.20-1.80], P < 0.001}. In addition, the occurrence of AVF thrombosis was significantly associated with higher all-cause mortality, whether VA was restored within 7 days [HR 1.34 (95% CI 1.02-1.75), P = 0.036] or later than 7 days [HR 1.81 (95% CI 1.29-2.53), P = 0.001].

    Conclusions: AVF/AVG thrombosis should be considered as a major clinical event since it is strongly associated with increased mortality in patients on maintenance HD, especially in the first 90 days after the event and when access restoration occurs >7 days after thrombosis. Clinicians should pay particular attention to the timing of VA restoration and the management of these patients during this high-risk period. The potential benefit of targeting overall patient risk with more aggressive treatment after AVF/AVG restoration should be further explored.

    Keywords: arteriovenous fistula; arteriovenous graft; cardiovascular mortality; chronic haemodialysis; survival; vascular access complication.

    Keywords：all-cause mortality; cardiovascular mortality

    关键词：动脉静脉瘘血栓形成; 全因死亡率; 心血管死亡率

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    期刊名：Clinical kidney journal

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    ISSN：2048-8505

    e-ISSN：2048-8513

    IF/分区：3.9/Q1

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    Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial