Vascular Access Morbidity and Mortality: Trends of the Last Decade
Vascular Access Morbidity and Mortality: Trends of the Last Decade
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DOI：
10.2215/cjn.01690213
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发表时间：
2013-07-01
影响因子：
9.8
通讯作者：
Foley, Robert
中科院分区：
文献类型：
--
作者：
Lok, Charmaine E.;Foley, Robert
在过去十年中，可以观察到血液透析血管通路的事件和流行类型的明显趋势。使用中心静脉导管开始血液透析的患者数量稳步增加，最近趋于稳定，约占所有事件通路的80%。瘘管的使用率也在稳步上升，目前在血液透析开始后4个月内超过50%。患者和血管通路相关的发病率和死亡率反映在开始和长期维持透析时使用的血管通路类型中。与瘘管或移植物相比，使用导管开始透析的患者感染并发症的风险增加了三到四倍，当导管用作普遍的通路时，风险增加了七倍。所有类型的访问程序率都增加了两到三倍。与导管使用相关的死亡风险显著增加，尤其是在透析开始的第一年内。
During the past decade, clear trends in the types of incident and prevalent hemodialysis vascular access can be observed. There has been a steady increase and recent stabilizaton of patients initiating hemodialysis with a central venous catheter, representing approximately 80% of all incident accesses. There has also been a steady increase in prevalent fistula use, currently greater than 50% within 4 months of hemodialysis initiation. Patient and vascular access related morbidity and mortality are reflected in the type of vascular access used at initiation and for long-term maintenance dialysis. There is a three- to fourfold increase in risk of infectious complications in patients initiating dialysis with a catheter compared with either a fistula or graft and a sevenfold higher risk when the catheter is used as a prevalent access. Procedure rates have increased two- to threefold for all types of access. There is a significant increased risk of mortality associated with catheter use, especially within the first year of dialysis initiation.