预透析 血管接入的位置和导管的使用在血液透析启动时
Michael Allon1, Alian Al-Balas1, Carlton J Young2
1Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
Clinical journal of the American Society of Nephrology : CJASN
|October 16, 2023
概括
对于需要透析的晚期慢性病 (CKD) 患者,动脉静脉移植 (AV移植) 比动脉静脉 (AV) 更有效地防止中央静脉导管的使用. 在大多数CKD患者中,AV移植导致无导管透析的启动.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血管外科 血管外科
- 透析服务 透析服务 透析服务
背景情况:
- 目前的指导方针建议在晚期慢性病 (CKD) 患者中放置动脉静脉 (AV) ,以避免使用中央静脉导管 (CVC) 进行血液透析.
- 有限的研究存在于预透析AV囊与AV移植放置的比较有效性.
- 血管接入对于血液透析至关重要,CVC与AV囊或移植相比,与更高的发病率和死亡率有关.
研究的目的:
- 为了比较预透析AV囊与AV移植在晚期CKD患者的结果.
- 评估透析启动的时间,无导管启动的可能性和访问程序的数量.
- 为临床决策提供信息,以确定接近末期病的CKD患者的最佳类型的血管接入.
主要方法:
- 对380名CKD患者进行回顾性研究,这些患者接受了大规模学术医疗中心的先导透析AV囊 (n=286) 或AV移植 (n=94) 放置.
- 收集的数据包括患者人口统计,手术时估计的淋巴细胞过率 (eGFR),从接入位置到透析开始的时间,以及需要CVC.
- 分析结果:血液透析启动的时间,无导管血液透析启动率和透析前血管接入程序的数量.
主要成果:
- 血液透析开始的中位时间因EGFR显著不同:69天 (<10毫升/分钟/1.73米2),156天 (10-14毫升/分钟/1.73米2) 和429天 (≥15毫升/分钟/1.73米2).
- 与AV塞相比,当EGFR<10毫升/分钟/1.73平方米 (88%对43%),10-14毫升/分钟/1.73平方米 (88%对54%) 时,无导管血液透析的启动显著更高.
- 与接受AV移植的患者相比,接受AV片的患者更有可能需要血管整形,手术修复,第二次访问安置和CVC插入.
结论:
- 在患有eGFR<15ml/min/1.73m2且接受血管接入手术的CKD患者中,与AV相比,AV移植显著降低了在透析开始时需要CVC的可能性.
- 在许多进行透析前的CKD患者中,AV移植似乎是及时和无导管透析的优越选择.
- 需要进一步的前性研究来证实这些发现,并优化预透析血管接入策略.
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