Natural history of tunneled dialysis catheters placed for hemodialysis initiation.
Natural history of tunneled dialysis catheters placed for hemodialysis initiation.
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DOI：
10.1016/j.jvir.2013.05.034
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发表时间：
2013-09
影响因子：
2.9
通讯作者：
Allon, Michael
中科院分区：
文献类型：
--
作者：
Shingarev, Roman;Barker-Finkel, Jill;Allon, Michael
超过80%的美国HD患者开始使用隧道透析导管（TDC）。已公布的TDC结果数据是基于流行和偶发TDC的病例组合。我们分析了在大量突发HD患者中首次放置tdc的影响通畅和并发症的因素。我们回顾性地查询了一个前瞻性的计算机化血管通路数据库，以确定472例首次接受TDC的患者。多变量生存分析用于确定影响TDC通畅（从放置到非选择性移除）和感染（从放置到导管相关菌血症首次发作）的临床参数。所有tdc的中位通畅时间为202天。左侧TDC放置是唯一与TDC通畅不良相关的变量（风险比1.98;95% CI, 1.39-2.81, p<0.0001）。左颈间段静脉（LIJ）插管6个月TDC通畅率为37%，右颈内静脉（RIJ）插管为54%。LIJ导管1年的通畅率为6%，RIJ导管为35%。导管通畅与患者年龄、性别、种族、高血压、糖尿病、冠状动脉疾病、外周血管疾病、脑血管疾病或心力衰竭无关。到导管相关菌血症首次发作的中位时间为163天。没有临床变量与TDC感染相关。tdc受到高感染率的困扰。应优先使用右IJ静脉TDC，以最大限度地提高导管通畅。
Over 80% of US patients initiate HD with a tunneled dialysis catheter (TDC). Published data on TDC outcomes are based on a case-mix of prevalent and incident TDCs. We analyzed factors affecting patency and complications of first TDCs ever placed in a large cohort of incident HD patients. We retrospectively queried a prospective, computerized vascular access database to identify 472 patients receiving a first ever TDC. Multiple variable survival analysis was used to identify clinical parameters affecting TDC patency (from placement to non-elective removal) and infection (from placement to first episode of catheter-related bacteremia). The median patency of all TDCs was 202 days. Left-sided placement of TDCs was the only variable associated with inferior TDC patency (hazard ratio 1.98; 95% CI, 1.39–2.81, p<0.0001). The 6-month TDC patency was 37% for left interval jugular (LIJ) vein catheters vs 54% for right internal jugular (RIJ) vein catheters. The one-year patency was 6% for LIJ catheters vs 35% for RIJ catheters. Catheter patency was not associated with patient age, sex, race, hypertension, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, or heart failure. The median time to the first episode of catheter-related bacteremia was 163 days. None of the clinical variables was associated with TDC infection. TDCs are plagued by high rates of infection. Right IJ vein TDC should be used preferentially to maximize catheter patency.
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影响因子：
6.1
作者：
Ewing, F;Patel, D;McBride, K
通讯作者：
McBride, K
影响因子：
1.6
作者：
Bozof, Ryan;Kats, Mark;Allon, Michael
通讯作者：
Allon, Michael
DOI：
10.2215/cjn.03900411
发表时间：
2011-09-01
影响因子：
9.8
作者：
Al-Solaiman, Yaser;Estrada, Erin;Allon, Michael
通讯作者：
Allon, Michael
影响因子：
9.6
作者：
Timsit, JF;Farkas, JC;Carlet, J
通讯作者：
Carlet, J
血管内导管相关感染的诊断和管理临床实践指南：2009年美国传染病学会的更新。
DOI：
10.1086/599376
发表时间：
2009-07-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Mermel LA;Allon M;Bouza E;Craven DE;Flynn P;O'Grady NP;Raad II;Rijnders BJ;Sherertz RJ;Warren DK
通讯作者：
Warren DK