Dialysis: Vascular access in children--arteriovenous fistula or CVC?
Dialysis: Vascular access in children--arteriovenous fistula or CVC?
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透析：儿童血管通路——动静脉瘘还是CVC？
DOI：
10.1038/nrneph.2012.265
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Warady,BradleyA
中科院分区：
文献类型：
--
作者：
Mak,RobertH;Warady,BradleyA
同期接受慢性透析的患者增加了58%，大多数移植受者在肾移植前接受了一个疗程的透析。1 2010年，北美儿科肾脏试验和合作研究（NAPRTCS）组报告的> 10，000例肾移植中只有24%是先发制人的。2尽管腹膜透析通常在大多数< 13岁的儿童中进行，3美国肾脏数据系统（USRDS）的2012年年度数据报告显示，血液透析是0-19岁患者中最常见的透析方式，占美国接受慢性透析治疗的2，377名儿童的59%。1等待肾移植的患者的治疗目标是优化护理并最大限度地降低发病率;因此，血液透析长期血管通路的最佳选择非常重要。尽管实施了美国瘘管第一次全国血管通路改进倡议4-旨在促进需要血液透析的患者适当使用动静脉瘘-但美国的儿科肾脏病社区继续优先使用中心静脉导管（CVC）作为血管通路的主要方法。根据2011年NAPRTCS年度报告，78.7%接受血液透析的儿童有CVC，只有极不成比例的少数儿童有动静脉瘘（11.8%）或动静脉移植物（6.7%）作为其初始血管通路。3同样，2009年USRDS报告称，74%的儿科患者将CVC用作初始血液透析通路。5
NEWS & VIEWS patients on chronic dialysis increased by 58% over the same period, and the majority of transplant recipients received a course of dialysis prior to kidney transplantation. 1 In 2010, only 24% of> 10,000 kidney transplantations reported by the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) group were pre-emptive. 2 Although peritoneal dialysis is commonly performed in the majority of children aged< 13 years, 3 the 2012 Annual Data Report of the United States Renal Data System (USRDS), showed that haemo dialysis was the most common dialysis modality in patients aged 0–19 years, accounting for 59% of the 2,377 children receiving chronic dialysis therapy in the USA. 1 The treatment goal for patients awaiting a kidney transplant is to optimize care and minimize morbidity; therefore, the best choice of long-term vascular access for haemo dialysis is important. Despite the implementation of the US Fistula First National Vascular Access Improvement Initiative4—which aims to promote the appropriate use of arteriovenous fistulas in patients who require haemodialysis—the paediatric nephrology community in the USA has continued to preferentially use central venous catheters (CVCs) as the primary method of vascular access. According to the 2011 NAPRTCS Annual Report, 78.7% of children who received haemodialysis had a CVC and only a very disproportionate minority had either an arteriovenous fistula (11.8%) or arteriovenous graft (6.7%), as their initial vascular access. 3 Similarly, in 2009 the USRDS reported that CVCs were used as the initial haemodialysis access in 74% of paediatric patients. 5