Objective: To investigate the effect of hyperphosphatemia on long-term patency of arteriovenous fistula (AVF) of patients with late fistula dysfunction/failure after reoperation. Methods: The study was carried out in the Department of Nephrology of the First Affiliated Hospital of Tsinghua University between March 2012 and March 2013. A total of 136 maintenance hemodialysis patients[73 males, 63 females, with an average age of (57.7±16.1) years]with late AVF dysfunction/faliure who received AVF reoperation were enrolled in the study. After follow-up for 3 years, 118 patients were left and divided into two groups: fistula dysfunction group (n=38), fistula patency group (n=80). Patients were aslo divided into two groups according to the blood phosphorus level: the blood phosphorus >1.78 mmol/L group (n=53) and the blood phosphorus ≤1.78 mmol/L group (n=65). t test was used to compare the serum phosphorus levels of patients with dysfunction group and fistula patency group. Patency rate was calculated by survival analysis method and log-rank test was used to compare secondary patency rate between groups of blood phosphorus >1.78 mmol/L and blood phosphorus ≤1.78 mmol/L. Multivariate Cox regression was used to analyze the influencing factors. Results: The average blood phosphorus level was significantly higher in dysfunction group[(1.87±0.42) mmol/L vs (1.65±0.39) mmol/L, P=0.008], and patency rate was significantly lower in patients of blood phosphorus>1.78 mmol/L group than that in patients of blood phosphorus ≤1.78 mmol/L (42.2% vs 60.4%, P=0.009). Blood phosphorus>1.78 mmol/L (RR=2.527, 95% CI: 1.272-5.023, P=0.008), diabetes (RR=2.667, 95% CI: 1.339-5.313, P=0.005) and C-reactive protein (CRP)>5 mg/L (RR=2.749, 95% CI: 1.324-5.710, P=0.007) were risk factors affecting secondary patency rate of internal fistua. Conclusion: Hyperphosphatemia is an independent risk factors for the patency rate of AVF after reoperation in hemodialysis patients.
目的： 观察高磷血症对维持性血液透析患者后期自体动静脉内瘘功能不良/失功再次手术后通畅率的影响。 方法： 前瞻性观察清华大学第一附属医院肾内科2012年3月至2013年3月后期自体动静脉内瘘功能不良/失功再次手术患者136例，男73例，女63例，年龄(57.7±16.1)岁，术后随访3年，随访结束共118例患者，依据内瘘通畅性分为失功组(38例)和通畅组(80例)，依据患者随访期间平均血磷水平分为高血磷组(>1.78 mmol/L，53例)和非高血磷组(≤1.78 mmol/L，65例)，采用log-rank检验比较高血磷组和非高血磷组内瘘的再次通畅率，采用多因素Cox回归分析影响内瘘再次通畅率的相关因素。 结果： 失功组患者血磷水平高于通畅组[(1.87±0.42)mmol/L比(1.65±0.39)mmol/L，P＝0.008]，高血磷组患者内瘘3年再次通畅率低于非高血磷组患者(42.2%比60.4%，P＝0.009)。血磷>1.78 mmol/L(RR＝2.527，95% CI：1.272～5.023，P＝0.008)，糖尿病(RR＝2.667，95% CI：1.339～5.313，P＝0.005)，C反应蛋白>5 mg/L(RR＝2.749，95% CI：1.324～5.710，P＝0.007)是影响内瘘再次通畅率的危险因素。 结论： 高磷血症是影响自体动静脉内瘘失功再次手术后通畅率的独立危险因素。.
Keywords: Arteriovenous fistula; Dysfunction/failure; Hemodialysis; Hyperphosphatemia.