تعیین میزان شیوع و بقاء روش‌های مختلف دستیابی عروقی در بیماران مبتلا به بیماری کلیوی مرحله انتهای (ESRD) تحت همودیالیز مزمن در تهران در سال 1384

    Background and Aim: Hemodialysis is the most common procedure which is performed for end-stage renal disease (ESRD) patients. Furthermore, vascular access is an important aspect of hemodialysis treatment, provided for patients with ESRD. There are different reports on the prevalence and survival of vascular access. In this study we report the prevalence and survival probability of vascular accesses in hemodialysis patients in Iran.Patients and Methods: This cross-sectional retrospective study was conducted in ESRD patients who underwent hemodialysis in Hemodialysis centers of Tehran, Iran in December 2004. In order to determine the prevalence and survival of different vascular access types, 700 hemodialysis patients and 198 accesses (from 100 patients) were studied, respectively. Data were collected by using recall method, interview and check lists. Life tables, Kaplan Meier procedure, Cox Regression and Log Rank tests were used in survival analysis. Statistical analysis was done with SPSS V. 13.Results: From 700 patients, Arteriovenous Fistula (AVF), Arteriovenous Graft (AVG)and Catheter were used by 93.4%, 3% and 3.6% of Iranian hemodialysis patients, respectively. The mean survival time of AVF was 144.52(95%CI 118.67 to 170.36) months compared with 32.43(95%CI 18.83 to 46.03) months for AVG. The results of Log Rank test demonstrated that this difference is significant (p=0.000). In addition, the estimated one, three and five year survival probability for AVF was 76.42%, 61.54% and 56.86%, respectively. Moreover, AVF survival time was significantly associated with the sites of access (p=0.0038).      Conclusion: Our findings showed greater survival of AVF compared with AVG and catheters. However we suggest that applying highly skilled surgical technique may improve access survival, patients' satisfaction and cost implications.