Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications.
Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications.
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DOI：
10.1053/j.ajkd.2012.09.006
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Lacson E Jr
中科院分区：
文献类型：
--
作者：
Xue H;Ix JH;Wang W;Brunelli SM;Lazarus M;Hakim R;Lacson E Jr
血液透析（HD）途径被认为是发病率的关键和可操作的决定因素，越来越多的文献表明，最初的HD途径类型是长期结局的重要标志。因此，我们在意外透析期间检查了HD获取情况，重点关注感染风险和第一个透析年内成功的瘘管形成。纵向队列：2007年1月1日至12月31日期间，所有美国成年人在第一次维持透析治疗的15天内入住费森尤斯北美医疗机构。HD开始时的血管通路类型HD开始时90天和第一年结束时的血管通路类型，一年内按通路类型划分的血液感染情况，以及导管并发症发生率。在25003例透析患者中，19622例（78.5%）采用导管透析，4151例（16.6%）采用瘘管透析，1230例（4.9%）采用移植物透析。90天时，14105例（69.7%）患者有导管，4432例（21.9%）患者有瘘管，1705例（8.4%）患者有移植物。在透析开始时，功能性瘘管和移植物的第一年失败率分别为10%和15%。移植物很少被瘘管取代（3%），而7064例（47.6%）开始使用单独导管的患者在1年时仍然只使用导管。总体而言，3327例（13.3%）患者在随访期间至少有一次血培养阳性，瘘管组和移植物组之间的风险相似，但导管组的风险高出约3倍（两种比较的p<0.001）。近三分之一的导管（32.5%）在41天的中位数时间内需要使用TPA， 59%的导管需要使用一次以上的TPA。由于后续血液培养结果不包括送往当地实验室的样本，因此可能低估菌血症。在大量具有代表性的美国透析患者中，在血液透析治疗的第一年，导管使用率仍然很高，并且与高机械并发症和血流感染率相关。
Hemodialysis(HD) access is considered a critical and actionable determinant of morbidity, with a growing literature suggesting that initial HD access type is an important marker of long term outcomes. Accordingly, we examined HD access during the incident dialysis period, focusing on infection risk and successful fistula creation over the first dialysis year. Longitudinal cohort All United States adults admitted to Fresenius Medical Care North America facilities within 15 days of first maintenance dialysis session between January 1 and December 31, 2007. Vascular access type at HD initiation Vascular access type at 90 days and at the end of the first year on HD, bloodstream infection within the first year by access type, and catheter complication rate. Amongst the 25,003 incident dialysis patients studied, 19,622(78.5%) initiated dialysis with a catheter, 4,151(16.6%) with a fistula, and 1,230(4.9%) with a graft. At 90 days, 14,105(69.7%) had a catheter, 4432(21.9%) patients had a fistula, and 1705(8.4%) had a graft. Functioning fistulas and grafts at dialysis initiation had first year failure rates of 10% and 15%, respectively. Grafts were seldom replaced by fistulas (3%), while 7,064 (47.6%) of all patients who initiated with a catheter alone still had only a catheter at 1 year. Overall, 3,327 (13.3%) patients had at least one positive blood culture during follow-up, with the risk being similar between fistula and graft groups, but approximately 3-fold higher in patients with a catheter (p<0.001 for either comparison). Nearly one in three catheters (32.5%) will require TPA use by median time of 41 days, with 59% requiring more than one TPA administration. Potential underestimation of bacteremia because follow-up blood culture results did not include samples sent to local laboratories. Among a large and representative population of incident US dialysis patients, catheter use remains very high over the first year of hemodialysis care, and is associated with high mechanical complication and blood stream infection rates.
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影响因子：
13.6
作者：
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