Vascular access survival in children and young adults receiving long-term hemodialysis
Vascular access survival in children and young adults receiving long-term hemodialysis
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DOI：
10.1053/j.ajkd.2004.12.010
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发表时间：
2005-04-01
影响因子：
13.2
通讯作者：
Fitzpatrick, MM
中科院分区：
文献类型：
--
作者：
Ramage, IJ;Bailie, A;Fitzpatrick, MM
背景资料：儿童长期血液透析治疗的实施因较小的血管口径和血液透析通路的潜在终身需求而变得复杂。各种因素导致了带套囊中心静脉导管（CVL）的使用率高于自体动静脉瘘（AVF）和动静脉合成移植物（AVG）。本研究的目的是比较CVL、AVF和AVG的生存率，并确定影响其生存率的因素。方法：对接受长期血液透析治疗的儿科患者进行20年的回顾性研究。在每次手术时记录年龄、身高、体重、体重指数和性别，以及是否存在低白蛋白血症、基础诊断、血管通路类型和部位以及既往通路手术的影响。记录操作者的等级。结果如下：对114例患者进行了304例血管通路手术，初始通路形成时的中位年龄为12.0岁（范围：4周至21.9岁）。最常见的手术是CVL插入（182例手术），然后是AVF形成（107例手术），仅创建了15个AVG。AVF的中位删失生存期为3.14年（95%置信区间，1.22 - 5.06），CVL为0.6年（95%置信区间，0.20 - 1.00）。对血管通路存活率产生不利影响的因素包括年龄较小、实习操作员、存在低白蛋白血症和所采用的通路类型，AVF优于CVL。结论：本研究显示AVF的存活率高于CVL和AVG。儿童和青少年的血管通路可能会影响未来的透析可及性，应由每种技术最有经验的人进行。(c)2005年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: The delivery of long-term hemodialysis therapy in children is complicated by smaller vascular caliber and the potential lifelong requirement for hemodialysis access. Various factors have resulted in the increased use of cuffed central venous catheters (CVLs) in preference to autologous arteriovenous fistulae (AVFs) and arteriovenous synthetic grafts (AVGs). The aim of this study is to compare CVL, AVF, and AVG survival and determine factors affecting their survival. Methods: A 20-year retrospective study was undertaken of pediatric patients receiving long-term hemodialysis therapy. Age, height, weight, body mass index, and sex were noted at each procedure, in addition to the presence of hypoalbuminemia, underlying diagnosis, type and site of vascular access, and effect of previous access surgery. The grade of operator also was noted. Results: Three hundred four vascular access procedures were performed on 114 patients, with a median age at initial access formation of 12.0 years (range, 4 weeks to 21.9 years). The most common procedure was CVL insertion (182 procedures) and then AVF formation (107 procedures), with only 15 AVGs created. Median censored survival was 3.14 years (95% confidence interval, 1.22 to 5.06) for AVFs and 0.6 years (95% confidence interval, 0.20 to 1.00) for CVLs. Factors adversely affecting vascular access survival were younger age, trainee operator, presence of hypoalbuminemia, and type of access undertaken, with AVF better than CVL. Conclusion: This study shows increased survival of AVFs over CVLs and AVGs. Vascular access in children and adolescents may impact on future dialysis accessibility and should be undertaken by those most experienced in each technique. (c) 2005 by the National Kidney Foundation, Inc.