ABSTRACT
Objective:To analyze the prognostic factor of arteriovenous fistula (AVF) maturation and provide the theoretical basis for the hemodialysis patients' AVF surgery.Methods:Retrospective investigation was conducted on patients that underwent AVF surgery in Wuhan Central Hospital from January 2017 to June 2019 as study subjects to investigate the prognostic factor of AVF maturation. The general information, hematological indicators, preoperative and postoperative ultrasound data of patients were recorded. Patients were divided into mature group and immature group according to the physical examination status, functional status and postoperative color doppler ultrasound data after AVF surgery, and the differences between the two groups were compared. Logistic regression analysis was used to analyze the prognostic factors of AVF maturation, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor for AVF maturation.Results:A total of 164 patients were included, including 110 patients in the mature group and 54 patients in the immature group. There were statistically significant differences between the two groups in surgical vein diameter, surgical artery diameter, brachial artery flow, cardiac ejection fractions, systolic blood pressure, diastolic blood pressure and history of diabetes (all P<0.05), while there were no statistically significant differences in other indicators such as gender, age, etc. Logistic regression analysis showed that preoperative surgical artery diameter (every increase by 0.1 mm, OR=1.402, 95% CI 1.159-1.697, P=0.001), surgical vein diameter (every increase by 0.1 mm, OR=1.341, 95% CI 1.176-1.528, P<0.001), cardiac ejection fraction (every increase by 5%, OR=1.184, 95% CI 1.087-1.289, P<0.001), systolic blood pressure (every increase by 10 mmHg, OR=1.407, 95% CI 1.103-1.796, P=0.006), brachial artery flow (every increase by 10 ml/min, OR=1.047, 95% CI 1.004-1.091, P=0.034) and history of diabetes ( OR=0.271, 95% CI 0.103-0.715, P=0.008) were the independent influencing factors for AVF maturation. ROC curve showed that preoperative surgical artery diameter ( AUC=0.728, 95% CI 0.643-0.839, P<0.001), surgical vein diameter ( AUC=0.762, 95% CI 0.686-0.839, P<0.001), cardiac ejection fraction ( AUC=0.711, 95% CI 0.626-0.796, P<0.001) were the important indicators for predicting AVF maturation. Conclusions:Preoperative surgical artery diameter, surgical vein diameter, cardiac ejection fraction and diabetes mellitus are the prognostic factors of AVF maturation. In preoperative vascular assessment, attention should be paid to the diameter of target arteries and veins, as well as to the cardiac function and diabetes mellitus of patients.
ABSTRACT
Objective:To assess the impact of kidney damage on the progression and prognosis of coronavirus disease 2019 (COVID-19) patients.Methods:The databases including CNKI, Wanfang Chinese Academic Journal Database, Pubmed, EMBASE and Cochrane databases were searched. The data retrieval period was from December 2019 to June 2020. During this period, RevMan 5.2 was used to extract and analyze data from the literature.Results:In this study, 15 articles, covering 11 448 COVID-19-related cases, were selected from the target databases. Meta-analysis results indicated that, for COVID-19 patients with acute kidney injury (AKI), the proportion of COVID-19 patients with AKI who received intensive care unit (ICU) treatment was significantly higher than that of patients without AKI ( OR=10.83, 95% CI 9.43-12.45, Z=33.53, P<0.001). Among them, the Asian group of COVID-19 patients with AKI accounted for 3.4% of all COVID-19 patients. The Asian group of COVID-19 patients with AKI who received ICU treatment accounted for 74.1% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the Asian group receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=18.66, 95% CI 9.85-35.34, Z=8.98, P<0.001). COVID-19 patients with AKI in the European and American groups accounted for 36.5% of all COVID-19 patients, and the European and American groups of COVID-19 patients with AKI who received ICU treatment accounted for 53.3% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the European and American groups receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=10.58, 95% CI 9.18-12.21, Z=32.40, P<0.001). The death risk of COVID-19 patients with AKI was significantly higher than that of patients without AKI ( OR=56.46, 95% CI 15.86-200.96, Z=6.23, P<0.001). COVID-19 patients with renal impairment had a higher risk of worsening and death than those without renal impairment ( OR=6.40, 95% CI 4.14-9.90, Z=8.36, P<0.001). Subgroup analysis showed COVID-19 patients with positive urine protein had a higher risk of worsening and death than those without positive urine protein ( OR=6.27, 95% CI 3.88-10.14, Z=7.49, P<0.001), and COVID-19 patients with elevated serum creatinine had a higher risk of worsening and death than those without elevated serum creatinine ( OR=7.13, 95% CI 2.58-19.72, Z=3.79, P<0.001). Conclusions:Patients with COVID-19 combined with AKI or only with positive urine protein and elevated serum creatinine are the risk factors for aggravation and even death. It is recommended that, in the diagnosis and treatment of COVID-19 patients, an optimization plan should be adopted to avoid or reduce the burden on the kidneys, meanwhile the patients' kidney damage should be paid closely attention to for protection and treatment in the early stage to avoid the occurrence of AKI. For patients who already suffered from AKI, replacement therapy, which would prevent these patient's condition from getting worse or even death, should be promptly implemented to alleviate the impact of kidney damage.