Abstract：
OBJECTIVE: Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD.
METHODS: A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed.
RESULTS: A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue (p = .005) and elevated contrast volume, with a mean of 40 mL (p = .027).
CONCLUSIONS: Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.
METHODS: A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed.
RESULTS: A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue (p = .005) and elevated contrast volume, with a mean of 40 mL (p = .027).
CONCLUSIONS: Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.
摘要：
目的：先前的研究表明，在介入相关干预措施中使用的低对比量对慢性肾脏病（CKD）的进展影响有限，但研究是有限和异质的。我们试图评估晚期CKD患者在纤维造影后1个月内进展到透析（HD）的比率和相关因素。
方法：对CKDIV期和V期患者进行单机构回顾性队列分析，还没有高清，在2014年1月1日至2018年12月31日期间进行了纤维造影术.主要结果是1个月内进展为HD。其他变量以及与主要结果的关联，如医疗合并症，评估对比剂类型或体积.
结果：共有34例患者在开始HD之前接受了41次造瘘。7例患者（均为CKDV）在造影术后1个月内进展为HD。对于最终进展为HD的34例患者中的31例,造影图和HD之间的平均时间为271天。患有CKDIV的人平均在549天开始HD，而那些患有CKDV的人平均在190天开始HD。在平均539天的随访中，三名患者未开始HD。与1个月内进展为HD相关的唯一因素包括使用等值（p=0.005）和增加的对比体积，平均值为40mL（p=0.027）。
结论：虽然CKDIV患者在造瘘后1个月内没有需要HD，对于CKDV患者，使用较大的碘化对比剂体积与造影术后1个月内进展为HD相关。进一步的研究应调查碘化和替代方案的安全性（例如，二氧化碳）CKD患者的血管造影术或基于双工的HD访问程序中的造影剂，尤其是CKDV,还没有HD。
方法：对CKDIV期和V期患者进行单机构回顾性队列分析，还没有高清，在2014年1月1日至2018年12月31日期间进行了纤维造影术.主要结果是1个月内进展为HD。其他变量以及与主要结果的关联，如医疗合并症，评估对比剂类型或体积.
结果：共有34例患者在开始HD之前接受了41次造瘘。7例患者（均为CKDV）在造影术后1个月内进展为HD。对于最终进展为HD的34例患者中的31例,造影图和HD之间的平均时间为271天。患有CKDIV的人平均在549天开始HD，而那些患有CKDV的人平均在190天开始HD。在平均539天的随访中，三名患者未开始HD。与1个月内进展为HD相关的唯一因素包括使用等值（p=0.005）和增加的对比体积，平均值为40mL（p=0.027）。
结论：虽然CKDIV患者在造瘘后1个月内没有需要HD，对于CKDV患者，使用较大的碘化对比剂体积与造影术后1个月内进展为HD相关。进一步的研究应调查碘化和替代方案的安全性（例如，二氧化碳）CKD患者的血管造影术或基于双工的HD访问程序中的造影剂，尤其是CKDV,还没有HD。
