Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines
Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines
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DOI：
10.1053/j.ajkd.2004.08.007
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发表时间：
2004-11-01
影响因子：
13.2
通讯作者：
Pisoni, RL
中科院分区：
文献类型：
--
作者：
Rayner, HC;Besarab, A;Pisoni, RL
背景资料：血液透析患者血管通路的肾脏疾病结局质量倡议指南建议使用自体动静脉（AV）内瘘而非AV移植物或导管作为永久性血管通路。他们建议在插管前让瘘管成熟大于或等于1个月。研究方法：透析结局和实践模式研究（DOPPS）提供了一种无与伦比的方法来检查血管通路实践模式和国际指南，特别关注与死亡风险的相关性。结果如下：欧洲和日本的大多数患者通过动静脉瘘进行透析，很少使用动静脉移植物;在美国，使用移植物的患者多于使用瘘。在开始透析前接受肾脏护理超过30天的患者通过动静脉瘘开始透析的机会明显更高。在美国，透析机构的医务主任通常更喜欢移植物;在欧洲和日本，大多数人更喜欢瘘管。在美国，瘘管形成和插管之间的平均时间相对较长，但瘘管存活率明显低于欧洲。隧道导管造成的死亡风险高于永久性通路，并与后续瘘管失败的风险增加相关。近年来，DOPPS国家中使用导管的患者比例有所增加。DOPPS数据表明，某些国家的绩效福尔斯不及其他国家的做法。动静脉瘘在美国的使用率很低，但一直在改善。大多数国家越来越多地使用导管的趋势令人沮丧。结论：DOPPS将继续监测实践趋势，并探索更多地应用指南是否会减少血液透析患者的入路并发症并延长其寿命。
Background: The Kidney Disease Outcomes Quality Initiative Guidelines for Vascular Access in hemodialysis patients recommend native arteriovenous (AV) fistulae over AV grafts or catheters for permanent vascular access. They recommend letting fistulae mature greater than or equal to1 month before cannulation. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides an unparalleled means to examine vascular access practice patterns and guidelines internationally, with particular attention to associations with mortality risk. Results: Most patients in Europe and Japan dialyze through AV fistulae and very few use AV grafts; in the United States, more patients use grafts than fistulae. Patients who receive nephrologic care for over 30 days before starting dialysis have significantly higher chances of commencing via AV fistula. Medical directors of dialysis facilities in the United States commonly prefer grafts; in Europe and Japan, most prefer fistulae. In the United States, there is a relatively long average time between fistula creation and cannulation but significantly worse fistula survival than that seen in Europe. Tunneled catheters pose a higher mortality risk than permanent accesses and are associated with increased risk of failure of a subsequent fistula. The percentage of prevalent patients in the DOPPS countries using catheters has increased in recent years. DOPPS data suggest that performance in some countries falls short of practices achieved in other countries. AV fistula use is low in the United States but has been improving. The trend of increasing use of catheters in most countries is discouraging. Conclusion: The DOPPS will continue to monitor practice trends and explore whether greater application of guidelines will lead to fewer access complications and improved longevity for hemodialysis patients.