CLINICAL EFFECT OBSERVATION OF COMPREHENSIVE MANAGEMENT OF VASCULAR ACCESS IN CHRONIC RENAL FAILURE

Kai Fu, Aili Guo, Yan He, Cheng Gong, Shen Xu, Xiuzhen Shi^*

Nephrology department, General Hospital of the Yangtze River Shipping, Wuhan, China. 430010

Objective: To investigate the clinical effect of comprehensive management of vascular access in chronic renal failure. 

Methods: A total of 206 patients with chronic renal failure who received the first dialysis treatment in our hospital from March 2015 to December 2021 were selected and divided into group A (patients were dialysis with autologous arteriovenous fistula, n=100), group B (patients were converted to autologous arteriovenous fistula from temporary or long-term hemodialysis catheter, n=76 and group C (patients receiving temporary or long-term hemodialysis catheter dialysis, n=30) according to the different vascular access of the patients during dialysis treatment. The dialysis adequacy, renal function, inflammation, anemia indexes and the incidence of complications were compared among the three groups. 

Results: The decrease rate of urea nitrogen, blood flow in vascular access and urea clearance fraction in groups A and B were significantly higher than those in group C (P<0.05). After treatment, the levels of BUN and Cr in group A were strikingly lower than those before treatment and those in group C; the levels of BUN and Cr in group B were markedly lower than those before treatment and those in group C (P<0.05); the levels of BUN and Cr in group C were obviously lower than those before treatment (P<0.05). After treatment, the levels of IL-6, CRP and TNF-α in group A were remarkably lower than those before treatment and those in groups B and C, and the levels of IL-6, CRP and TNF-α in group B were dramatically lower than those before treatment and those in group C (P<0.05). After treatment, the level of EPO in group A was significantly lower than that before treatment and that in group C, and the level of Hb was markedly higher than that before treatment, and that in group B and group C (P<0.05); the level of EPO in group B was obviously lower than that before treatment and that in group C, and the level of Hb was significantly higher than that before treatment and that in group C (P<0.05). The total incidence of complications in group A was significantly lower than that in groups B and C (P<0.05). 

Conclusion: The use of autologous arteriovenous fistula as the vascular access for hemodialysis in patients with chronic renal failure has a good dialysis effect, and is beneficial to reduce the micro-inflammatory state of the body, improve the anemia state, and reduce the incidence of complications. Clinically, patients with chronic renal failure should be encouraged to avoid the use of central venous catheters and establish autologous arteriovenous fistulas as early as possible.