vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2025-1-160-171vtio-1881Research ArticleЗаместительная почечная терапияCARDIOVASCULAR ASPECTS OF TRANSPLANT SURGERYПервичная дисфункция артериовенозных фистул у пациентов на программном гемодиализе: распространенность, факторы риска и влияние на отдаленные результатыPrimary arteriovenous fistula failure in patients on maintenance hemodialysis: prevalence, risk factors, and impact on long-term outcomeshttps://orcid.org/0009-0007-0373-6071ЗулькарнаевА. Б.ZulkarnaevA. B.

Зулькарнаев Алексей Батыргараевич

Researcher ID: A-9250-2016

129110, Москва, ул. Щепкина, д. 61/2. Тел. (916) 705-98-99

Alexey Zulkarnaev

61/2, Shchepkina str., Moscow, 129110 Phone: (916) 705-98-99

7059899@gmail.comБыловК. В.BylovK. V.

Москва 

Moscow 

СтепановВ. А.StepanovV. A.

Москва 

Moscow 

ГБУЗ МО «Московский областной научно-исследовательский клинический институт имени М.Ф. Владимирского»РоссияVladimirsky Moscow Regional Research and Clinical InstituteRussian Federation202526032025271160171Copyright © Зулькарнаев А.Б., Былов К.В., Степанов В.А., 20252025Зулькарнаев А.Б., Былов К.В., Степанов В.А.Zulkarnaev A.B., Bylov K.V., Stepanov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1881

Цель: оценить распространенность первичной дисфункции артериовенозной фистулы (АВФ) у пациентов, начинающих лечение программным гемодиализом, оценить связь первичной дисфункции с долгосрочными результатами и выявить факторы риска ее развития. Материалы и методы. Ретроспективное когортное исследование описывает результаты лечения 1595 совершеннолетних пациентов, впервые начинающих лечение программным гемодиализом. Результаты. Первичная несостоятельность отмечена у 369 пациентов (23,1%), у 1226 пациентов (76,9%) АВФ созрела нормально и была доступна пункции без дополнительных вмешательств. Наблюдение врачом-нефрологом, предварительный осмотр врачом-хирургом и ультразвуковое исследование были ассоциированы со снижением риска первичной дисфункции: RR = 0,624 [95% ДИ 0,523; 0,746], р < 0,001; 0,648 [0,469; 0,894], р = 0,005; и 0,606 [0,471; 0,78], р < 0,001 (в случае если ультразвуковое исследование выполнено хирургом или в его присутствии 0,372 [0,24; 0,577], р < 0,001) соответственно. Риск первичной дисфункции возрастал в случае формирования АВФ за две и за одну неделю, а также в течение первой и второй недель после начала гемодиализа. В однофакторном анализе первичная дисфункция была сопряжена с увеличением риска смерти от всех причин (HR = 1,54 [1,20; 1,97], р < 0,001), но не после коррекции на возраст и коморбидность (HR = 1,11 [0,85; 1,44], р = 0,761). Первичная дисфункция сопряжена с ухудшением вторичной проходимости (HR = 1,79 [1,28; 2,51] р < 0,001) и увеличением потребности в реконструктивных вмешательствах (IRR = 2,199 [1,985; 2,434], р < 0,001). Выводы. Факторами снижения риска первичной дисфункции являются наблюдение врачом-нефрологом, предварительный осмотр врачом-хирургом, дополненный ультразвуковым исследованием. Первичная дисфункция не ассоциирована со снижением выживаемости пациентов (после коррекции на коморбидный фон и возраст), но ассоциирована со снижением вторичной проходимости сосудистого доступа.

Objective: to assess the prevalence of primary arteriovenous fistula (AVF) failure in patients commencing chronic hemodialysis, to evaluate the relationship between primary failure and long-term outcomes, and to identify risk factors for its development. Materials and methods. This retrospective cohort study reports the outcomes of 1595 adult patients starting chronic hemodialysis treatment for the first time. Results. Primary failure was noted in 369 patients (23.1%), whereas in 1,226 patients (76.9%), the AVF matured normally and was accessible to puncture without additional interventions. Follow-up by a nephrologist, preoperative evaluation by a surgeon, and ultrasound were linked to a lower risk of primary failure: RR = 0.624 [95% CI 0.523; 0.746], p < 0.001; 0.648 [0.469; 0.894], p = 0.005; and 0.606 [0.471; 0.78], p < 0.001 (when ultrasound was performed by or in the presence of a surgeon 0.372 [0.24; 0.577], p < 0.001), respectively. The risk of primary failure increased if AVF was created in two weeks and one week before, and during the first and second weeks after hemodialysis initiation. In single-factor analysis, primary failure was linked to a higher risk of all-cause mortality (HR = 1.54 [1.20; 1.97], p < 0.001), but not after adjustment for age and comorbidity (HR = 1.11 [0.85; 1.44], p = 0.761). Primary failure was associated with poorer secondary patency (HR = 1.79 [1.28; 2.51] p < 0.001) and increased need for reconstructive interventions (IRR = 2.199 [1.985; 2.434], p < 0.001). Conclusion. Risk reduction factors for primary failure include follow-up by a nephrologist, preliminary examination by a surgeon, supplemented by ultrasound scan. Primary failure is not linked to decreased patient survival (after adjustment for comorbid background and age), but to decreased secondary patency of vascular access.

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The authors declare that there are no conflicts of interest present.