透析剂重复使用对血液透析治疗患者的存活率的影响
H I Feldman1, M Kinosian, W B Bilker
1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia 19104-6021, USA.
JAMA
|August 28, 1996
概括
在独立的美国透析设施中,再使用透析剂与酸/乙酸可能会增加患者的死亡率. 像甲这样的替代杀菌剂显示没有显著的生存差异,这引发了对患者安全的担忧.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 医疗设备再加工 医疗设备再加工
背景情况:
- 透析器的重复使用是血液透析的常见做法,以降低成本.
- 选择再加工灭菌剂可能会影响患者的治疗结果.
- 之前的研究对透析器重复使用的安全性产生了不同的结果.
研究的目的:
- 研究美国血液透析患者的透析器重复使用实践和患者存活率之间的关联.
- 为了比较不同再处理杀菌剂对血液透析患者存活率的影响.
主要方法:
- 一项非并发的队列研究,涉及1986-1987年期间在美国启动血液透析的27,938名患者.
- 患者的存活率是主要的结局指标.
- 分析基于再加工状态和使用的灭菌剂 (乙/酸,甲,甲) 在独立和医院设施中的生存率进行了比较.
主要成果:
- 与非再加工设施相比,在独立设施中用酸/酸再加工透析器与较高的死亡率 (RR,1.10;P=.02) 有关.
- 在独立的设施中进行甲和甲再处理时,生存率没有显著差异.
- 对于在医院再加工设施中使用的任何杀菌剂,没有观察到显著的生存差异.
结论:
- 在独立的透析设施中重新处理白酸/酸可能与患者的存活率降低有关.
- 需要进一步调查,以确定增加的死亡率是由于患者的并发症,程序质量,或直接无菌剂毒性.
- 这些发现凸显了美国血液透析患者可避免死亡率的潜在担忧.
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