Prehemodialysis arteriovenous access creation is associated with better cardiovascular outcomes in patients receiving hemodialysis: A population-based cohort study

Cheng Chieh Yen, Mei Yin Liu, Po Wei Chen, Peir Haur Hung, Tse Hsuan Su, Yueh Han Hsu

研究成果: Article

摘要

Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan ABSTRACT Background: Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. Methods: We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients' characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period. Results: The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin-angiotensin-aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48-0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39-0.59]). Sensitivity analyses obtained consistent results. Conclusions: Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.

原文English
文章編號6680
期刊PeerJ
2019
發行號4
DOIs
出版狀態Published - 2019 一月 1

指紋

hemodialysis
cohort studies
Renal Dialysis
Cohort Studies
Hazards
heart failure
Mortality
Hematinics
Health insurance
Population
Hospitalization
Dialysis
Nursing
Heart Failure
Angiotensins
Aldosterone
Taiwan
Health care
Renin
Medicine

All Science Journal Classification (ASJC) codes

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

引用此文

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title = "Prehemodialysis arteriovenous access creation is associated with better cardiovascular outcomes in patients receiving hemodialysis: A population-based cohort study",
abstract = "Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan ABSTRACT Background: Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. Methods: We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients' characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period. Results: The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin-angiotensin-aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35{\%} lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95{\%} confidence interval (CI) [0.48-0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52{\%} lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95{\%} CI [0.39-0.59]). Sensitivity analyses obtained consistent results. Conclusions: Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.",
author = "Yen, {Cheng Chieh} and Liu, {Mei Yin} and Chen, {Po Wei} and Hung, {Peir Haur} and Su, {Tse Hsuan} and Hsu, {Yueh Han}",
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Prehemodialysis arteriovenous access creation is associated with better cardiovascular outcomes in patients receiving hemodialysis : A population-based cohort study. / Yen, Cheng Chieh; Liu, Mei Yin; Chen, Po Wei; Hung, Peir Haur; Su, Tse Hsuan; Hsu, Yueh Han.

於: PeerJ, 卷 2019, 編號 4, 6680, 01.01.2019.

研究成果: Article

TY - JOUR

T1 - Prehemodialysis arteriovenous access creation is associated with better cardiovascular outcomes in patients receiving hemodialysis

T2 - A population-based cohort study

AU - Yen, Cheng Chieh

AU - Liu, Mei Yin

AU - Chen, Po Wei

AU - Hung, Peir Haur

AU - Su, Tse Hsuan

AU - Hsu, Yueh Han

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan ABSTRACT Background: Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. Methods: We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients' characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period. Results: The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin-angiotensin-aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48-0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39-0.59]). Sensitivity analyses obtained consistent results. Conclusions: Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.

AB - Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan ABSTRACT Background: Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. Methods: We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients' characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period. Results: The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin-angiotensin-aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48-0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39-0.59]). Sensitivity analyses obtained consistent results. Conclusions: Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.

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