Hemodialysis International最新文献_第7页

Elevated Trimethylamine-N-oxide (TMAO) Is Associated with Vascular Access Dysfunction in Maintenance Hemodialysis Patients 三甲胺- n -氧化物（TMAO）升高与维持性血液透析患者血管通路功能障碍有关

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-20 DOI: 10.1111/hdi.13255

Yin Zheng, Yuan Ren, Li You, Junfeng Liu, Jun Xue

Introduction

Elevated levels of trimethylamine-N-oxide (TMAO), a metabolite produced by gut microbiota, have been associated with cardiovascular diseases and complications in various populations. However, its role in vascular access dysfunction in hemodialysis patients remains underexplored. This study investigates the potential relationship between TMAO levels and vascular access dysfunction in maintenance hemodialysis patients.

Methods

This study included 80 hemodialysis patients. The baseline serum TMAO levels were measured, and clinical characteristics and dialysis-related data were collected. They were followed up on vascular access dysfunction events over a period of 1 year. The association between serum TMAO levels and vascular access dysfunction events were investigated.

Findings

In our cohort, we observed a wide distribution of serum concentrations, with a median concentration of 15.2 μmol/L and a maximum concentration of 245.3 μmol/L. Patients were stratified into a low-TMAO group and a high-TMAO group according to the median value of TMAO concentrations. Those in the high-TMAO group had a significantly higher incidence of vascular access dysfunction events (p = 0.023). TMAO was independently associated with vascular access dysfunction events after adjusting for some potential vascular access dysfunction risk factors.

Discussion

This study suggests that elevated serum TMAO levels may serve as an independent risk factor for vascular access dysfunction in hemodialysis patients. Reducing TMAO levels may potentially decrease the incidence of vascular access dysfunction, warranting further investigation into this therapeutic approach.

简介：三甲胺- n -氧化物（TMAO）是肠道微生物群产生的代谢物，其水平升高与各种人群的心血管疾病和并发症有关。然而，其在血液透析患者血管通路功能障碍中的作用仍未得到充分探讨。本研究探讨维持性血液透析患者TMAO水平与血管通路功能障碍之间的潜在关系。方法：本研究纳入80例血液透析患者。测量基线血清TMAO水平，并收集临床特征和透析相关数据。对他们进行了为期一年的血管通路功能障碍随访。研究了血清TMAO水平与血管通路功能障碍事件之间的关系。结果：在我们的队列中，我们观察到血清浓度分布广泛，中位浓度为15.2 μmol/L，最大浓度为245.3 μmol/L。根据TMAO浓度中位数将患者分为低TMAO组和高TMAO组。高tmao组血管通路功能障碍事件发生率显著高于对照组（p = 0.023）。在调整了一些潜在的血管通路功能障碍危险因素后，TMAO与血管通路功能障碍事件独立相关。讨论：本研究提示血清TMAO水平升高可能是血液透析患者血管通路功能障碍的独立危险因素。降低TMAO水平可能潜在地降低血管通路功能障碍的发生率，需要进一步研究这种治疗方法。

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引用次数: 0

Use of a Reentry Device for Endovascular Recanalization of Central Venous Occlusions Associated With Failing Hemodialysis Access 再入装置在血液透析通路失败相关中心静脉闭塞血管内再通中的应用。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-20 DOI: 10.1111/hdi.13262

Yonghun Kim, Jeong Min Lee, Jee Hyun Baek, Tae Won Choi, Jinoo Kim, Je Hwan Won, Yohan Kwon

Introduction

To evaluate the technical feasibility and safety of a reentry device for endovascular recanalization of central venous occlusions associated with dysfunctional arteriovenous fistulas.

Methods

Between January 2013 and December 2023, 20 patients (13 women; mean age, 61.1 years) with dysfunctional fistulas attributed to central venous occlusion underwent treatment using an Outback LTD reentry device. All patients had experienced unsuccessful recanalization attempts using conventional endovascular techniques. Symptoms included increased venous pressure during hemodialysis (N = 8), arm swelling (N = 8), absence of flow (N = 1), graft thrombosis (N = 2), and maturation failure (N = 1). The mean age of the fistulas was 56.1 months, and 11 patients had a history of angioplasty. An Outback LTD reentry device was used when conventional endovascular techniques were unsuccessful.

Findings

Occlusions were observed at the junction of the subclavian and innominate veins (N = 15) and in the right innominate vein (N = 2), subclavian vein (N = 1), and axillary vein of the arm (N = 2). The reentry device was introduced via the fistula (N = 11), femoral vein (N = 8), or internal jugular vein (N = 1). Technical success was achieved in 18 patients (90.0%), all of whom successfully underwent hemodialysis. Eight patients with arm swelling experienced symptom relief. In the 14 patients available for long-term follow-up, the mean intervention-free period was 5.0 months, and the mean functional period of the fistula, with or without subsequent endovascular treatment, was 23.0 months. No complications were observed.

Discussion

An Outback reentry device may be used for central venous occlusions when conventional techniques are unsuccessful.

目的：评价一种再入装置用于功能不全动静脉瘘相关中心静脉闭塞血管内再通的技术可行性和安全性。方法：2013年1月至2023年12月，20例患者(女性13例；平均年龄61.1岁)，中心静脉闭塞导致功能不全瘘管，使用Outback LTD再入装置治疗。所有患者均经历了常规血管内技术再通失败的尝试。症状包括血液透析期间静脉压升高（N = 8），手臂肿胀（N = 8），血流缺失（N = 1），移植物血栓形成（N = 2）和成熟失败（N = 1）。患者平均年龄56.1个月，11例患者有血管成形术史。当常规血管内技术失败时，使用Outback LTD再入装置。结果：锁骨下静脉与无名静脉交界处（N = 15）、右侧无名静脉（N = 2）、锁骨下静脉（N = 1）、上臂腋静脉（N = 2）闭塞。再入装置经瘘管（N = 11）、股静脉（N = 8）或颈内静脉（N = 1）置入。18例患者（90.0%）获得技术成功，均成功进行了血液透析。8例手臂肿胀患者症状缓解。在14例可长期随访的患者中，平均无干预期为5.0个月，平均瘘功能期为23.0个月，无论是否进行后续血管内治疗。无并发症发生。讨论：当常规技术不成功时，可使用Outback再入装置治疗中心静脉阻塞。

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引用次数: 0

Impact of Intradialytic Weight Gain on Left Ventricular Function and Characteristics in Hemodialysis Patients 血液透析患者体内体重增加对左心室功能及特征的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-20 DOI: 10.1111/hdi.13257

Marieta P. Theodorakopoulou, Vasileios Anastasiou, Fotini Iatridi, Vasileios Kamperidis, Artemios Karagiannidis, Eleni Karkamani, Areti Georgiou, Erasmia Sampani, Konstantinos Tsilonis, Antonios Ziakas, Pantelis Sarafidis

Background

Pulmonary circulation is particularly overloaded in hemodialysis patients with high interdialytic weight gain (IDWG), as evidenced by deterioration in right ventricular function indices. This study aimed to evaluate the impact of the degree of fluid accumulation on left ventricular (LV) systolic and diastolic function and sizing characteristics.

Methods

This is a post hoc analysis of a cross-over study in 41 hemodialysis patients. Study participants were stratified using the recommended threshold IDWG% into a higher (> 4.5%) and a lower (< 4.5%) IDWG% group. All participants underwent 4 echocardiographic assessments at the start and the end of the 2-day and the 3-day interdialytic interval.

Results

Over the 2-day interval, stroke volume and cardiac output increments were more prominent in the higher IDWG% group (> 4.5% 22.97 ± 18.45 vs. < 4.5% 0.95 ± 29.1 mmHg, p = 0.006; > 4.5% 1.32 ± 1.39 vs. < 4.5% −0.36 ± 2.08 L/m², p = 0.004, respectively). Over the 3-day interval, significant increments in stroke volume were observed for both groups. With regard to diastolic function, a significant increase in E wave, E/A, and E/E'm lateral ratios was observed over the 3-day interval, and significant between-group differences in interdialytic changes were detected for the E/A ratio (IDWG > 4.5% 0.35 ± 0.29 vs. < 4.5% 0.06 ± 0.44, p = 0.035) and the E wave (IDWG > 4.5% 0.31 ± 0.24 vs. < 4.5% 0.10 ± 0.19, p = 0.02). Left atrial dimensions and LV mass were enlarged to a similar extent in both study groups during both intervals.

Conclusions

Patients exceeding the recommended IDWG threshold experience more pronounced changes in indices of LV function and significant deterioration of preload-dependent indexes of LV diastolic function.

背景：在透析期间体重增加（IDWG）高的血液透析患者中，肺循环负荷特别重，右心室功能指数恶化就是证据。本研究旨在评估液体积聚程度对左心室收缩和舒张功能及大小特征的影响。方法：对41例血液透析患者的交叉研究进行事后分析。研究参与者使用推荐阈值IDWG%进行分层，分为较高（> 4.5%）和较低(结果：在2天间隔内，IDWG%较高组的脑卒中量和心输出量增量更为突出（> 4.5% 22.97±18.45 vs. 4.5% 1.32±1.39 vs. 2, p = 0.004）。在3天的间隔时间内，两组的脑卒中量均有显著增加。在舒张功能方面，在3天的间隔时间内观察到E波、E/ a和E/E侧比的显著增加，并且发现E/ a比（IDWG > 4.5% 0.35±0.29 vs. 4.5% 0.31±0.24 vs.）的透析间期变化组间差异显著。结论：超过推荐的IDWG阈值的患者左室功能指标变化更明显，左室舒张功能前负荷依赖指标明显恶化。

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引用次数: 0

Palliative Care and Advance Care Planning Integration Into a Hospital-Based Outpatient Dialysis Care Team: A Quality Improvement Intervention 姑息治疗和预先护理计划整合到医院门诊透析护理团队：质量改善干预

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-13 DOI: 10.1111/hdi.13249

Joanna L. Martin, Aleksandra Gmurczyk, Joshua Hauser, Joanna R. Varghese, Julie Ozersky, Tyra D. Oliver, Yinglin Xia, Michael J. Fischer

引用次数: 0

Experience with Arteriovenous Fistula in Elderly Patients with Chronic Kidney Disease 老年慢性肾病患者动静脉瘘的治疗体会。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-12 DOI: 10.1111/hdi.13247

Güler Gülsen Ersoy, Burak Tamtekin, İsmail Taşkent

Objectives

In recent years, advances in medical care have expanded the boundaries of aging, leading to an increasing number of elderly individuals requiring hemodialysis (HD). The use of arteriovenous (AV) fistulas for HD in elderly patients remains controversial due to concerns about life expectancy, vascular aging, and comorbidities. This study aimed to compare AVF outcomes in patients aged ≥ 70 years with those aged < 70 years to evaluate the safety and efficacy of AVFs in elderly patients.

Materials and Methods

This retrospective, single-center study included 202 patients who underwent AVF creation for end-stage kidney disease between 2022 and 2024. Patients were divided into two groups: ≥ 70 years (n = 76) and < 70 years (n = 126). AVF maturation, complication rates, the need for new AVF, and primary and secondary patency rates were compared. Kaplan–Meier analysis and the log-rank test were used to assess patency outcomes.

Results

AVF maturation rates were comparable between the ≥ 70 years group (50.0%) and the < 70 years group (56.9%) (p = 0.330). The need for a new AVF within 6 months was 11.2% in the ≥ 70 years group and 17.6% in the < 70 years group (p = 0.387). There were no significant differences in late complications (p = 0.157), AVF location preferences (p = 0.450), or secondary intervention rates (p = 0.967). Kaplan–Meier analysis revealed no significant difference in primary (p = 0.411) or secondary (p = 0.432) patency between the two groups.

Conclusion

Despite age-related concerns, AVF outcomes in elderly patients were comparable to those in younger individuals. AVFs should be considered a viable vascular access option for HD in elderly patients, provided that patient-specific factors are taken into account.

目的：近年来，医疗保健的进步扩大了老龄化的界限，导致越来越多的老年人需要血液透析（HD）。由于对预期寿命、血管老化和并发症的担忧，老年HD患者使用动静脉（AV）瘘管仍然存在争议。本研究旨在比较≥70岁患者与老年患者的AVF结局。材料和方法：这项回顾性、单中心研究纳入了2022年至2024年间因终末期肾病接受AVF创建的202例患者。患者被分为两组：≥70岁组（n = 76）。结果：≥70岁组的AVF成熟率相当（50.0%）。结论：尽管存在年龄相关的担忧，但老年患者的AVF结局与年轻人相当。如果考虑到患者的特定因素，avf应被视为老年HD患者可行的血管通路选择。

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引用次数: 0

Tigecycline Induced Sweet Syndrome in a Patient on Maintenance Hemodialysis 替加环素致维持性血液透析患者甜蜜综合征1例。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-05-12 DOI: 10.1111/hdi.13248

Periklis Dousdampanis, Eleni Koutroulia, Pinelopi Nterma, Christos Siavelis, Elefteria Sarri, Georgia Kiriakou, Panagiotis Aroukatos, Zoi Tegou

Sweet syndrome or acute febrile neutrophilic dermatosis is a very uncommon condition, especially in patients on chronic hemodialysis. Sweet syndrome is characterized by painful erythematous plaques, papules, and nodules of abrupt onset, associated with fever and malaise. We describe a 44-year-old woman on chronic hemodialysis due to diabetic nephropathy who developed Sweet syndrome after intravenous administration of tigecycline due to an enterococcus infection. There is a paucity of data regarding Sweet syndrome in hemodialysis patients; nevertheless, this syndrome merits more attention in nephrological clinical practice. We suggest that Sweet syndrome should be considered if the abrupt appearance of erythematous plaques and nodules with fever is presented in a hemodialysis patient. Nephrologists should be aware of this uncommon condition in order to timely recognize this syndrome. Interestingly, tigecycline is another drug implicated in the development of drug-induced Sweet syndrome.

甜综合征或急性发热性中性粒细胞皮肤病是一种非常罕见的疾病，特别是在慢性血液透析患者中。甜综合征的特点是突然发作疼痛的红斑斑块、丘疹和结节，伴有发烧和不适。我们描述了一位44岁的女性，由于糖尿病肾病而进行慢性血液透析，她在静脉注射替加环素后因肠球菌感染而出现Sweet综合征。关于血液透析患者的Sweet综合征的数据缺乏；然而，在肾内科临床实践中，该综合征值得更多的关注。我们建议，如果血液透析患者突然出现红斑斑块和结节并伴有发热，应考虑Sweet综合征。肾病学家应该意识到这种不常见的情况，以便及时识别这种综合征。有趣的是，替加环素是另一种与药物性Sweet综合征有关的药物。

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引用次数: 0

Variations in Serum Albumin Levels Over Time in Patients Treated With Conventional Hemodialysis or Expanded Hemodialysis: A Cohort Study 常规血液透析或扩展血液透析患者血清白蛋白水平随时间的变化：一项队列研究。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-29 DOI: 10.1111/hdi.13232

Juan C. Castillo, Jasmin Vesga, Angela Rivera, Peter Rutherford, Ricardo Sanchez, Henry Oliveros, Bengt Lindholm, Mauricio Sanabria, the Colombian Registry of Expanded Hemodialysis Investigators

Introduction

Hypoalbuminemia is a well-established risk factor for mortality in chronic hemodialysis (HD) patients. To evaluate the association of time-varying serum albumin with the type of dialyzer, we analyzed serum albumin over time in two cohorts of HD patients, one receiving HDx therapy enabled by the Theranova dialyzer and the other conventional HD with high-flux dialyzer (HF-HD).

Methods

In this cohort study, 1092 prevalent adult HD patients (mean age 61 years; 62% men; 42% had diabetes; 19% had cardiovascular disease) at Renal Care Services Colombia undergoing either HDx therapy enabled by Theranova dialyzer (n = 559) or HF-HD (n = 533) were enrolled between September 1, 2017, and November 30, 2017, and then underwent repeated measurements of serum albumin for up to 48 months. Sociodemographic and clinical, and laboratory characteristics at baseline were recorded, and a repeated-measures analysis of variance (ANOVA) was conducted to examine differences in means of serum albumin at different time points. To evaluate the association between dialysis membrane and albumin levels during the follow-up, a linear panel regression analysis was performed, allowing control for imbalances in the cohorts of baseline clinical and demographic variables, as well as the time-dependent variables.

Results

Mean albumin concentration remained above 3.8 g/dL and did not differ over time between HDx and HF-HD (p = 0.789). No association (p = 0.208) between serum albumin levels varying over time and the use of the Theranova dialyzer was found in the linear panel regression model. However, serum albumin was linked to both inflammatory and nutritional markers, including C-reactive protein, ratio of platelets to lymphocytes, and protein-energy wasting.

Conclusion

Variations in serum albumin levels over time were associated with protein-energy wasting, inflammation, high age, vascular access, and hospitalizations, but not with the type of dialyzer.

低白蛋白血症是慢性血液透析（HD）患者死亡的一个公认的危险因素。为了评估时变血清白蛋白与透析器类型的关系，我们分析了两组HD患者的血清白蛋白随时间的变化，一组接受Theranova透析器支持的HDx治疗，另一组接受高通量透析器（HF-HD）的传统HD。方法：在这项队列研究中，1092例流行的成人HD患者(平均年龄61岁；男性62%;42%患有糖尿病；在2017年9月1日至2017年11月30日期间，在哥伦比亚肾脏护理服务中心接受了由Theranova透析器支持的HDx治疗（n = 559）或HF-HD (n = 533)，然后进行了长达48个月的血清白蛋白重复测量。记录基线时的社会人口学、临床和实验室特征，并进行重复测量方差分析（ANOVA）来检查不同时间点血清白蛋白均值的差异。为了评估随访期间透析膜和白蛋白水平之间的关系，进行了线性面板回归分析，允许控制基线临床和人口统计学变量队列中的不平衡，以及时间相关变量。结果：平均白蛋白浓度保持在3.8 g/dL以上，在HDx和HF-HD之间没有随时间的差异（p = 0.789）。在线性面板回归模型中，血清白蛋白水平随时间变化与Theranova透析器的使用之间没有关联（p = 0.208）。然而，血清白蛋白与炎症和营养指标有关，包括c反应蛋白、血小板与淋巴细胞的比例和蛋白质能量消耗。结论：血清白蛋白水平随时间的变化与蛋白质能量消耗、炎症、高龄、血管通路和住院有关，但与透析器类型无关。

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引用次数: 0

Hemodynamic Monitoring During Hemodialysis Using Bioimpedance: A Comparison of Changes in Resistance Between Different Body Segments 利用生物阻抗监测血液透析过程中的血流动力学：不同身体部位间阻力变化的比较。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-28 DOI: 10.1111/hdi.13245

Melanie K. Schoutteten, Patrick van der Heijden, Astrid D. H. Brys, Bart De Moor, Chris van Hoof, Geert Langereis, Jeroen P. Kooman, Pieter M. Vandervoort

Introduction

Prevention of hemodynamic complications during hemodialysis remains challenging. Although whole body bioimpedance is well established in fluid status assessment, its use for dynamic or continuous recordings is limited. A segmental approach may serve this purpose better. This study investigates which body segment is best targeted to measure bioimpedance for hemodynamic monitoring.

Methods

In this observational study, serial bioimpedance measurements were conducted on the whole body, lower leg, upper arm, and thorax of 15 patients during two hemodialysis sessions. The resistance component of bioimpedance was used to investigate the relationship with changes in volume and systolic blood pressure (SBP).

Findings

Predialysis to postdialysis changes in relative resistance between the two sessions revealed the lowest intraclass correlation coefficient for upper arm (0.023) and the highest for thoracic resistance (0.728). Correlation between ultrafiltration volume and relative resistance was comparable between upper arm and thoracic segment (0.538 [0.447–0.618] and 0.537 [0.446–0.617], both p < 0.001, respectively) and the highest for whole-body and lower leg (0.697 [0.63–0.754] and 0.670 [0.598–0.731], both p < 0.001, respectively). In contrast, the correlation between changes in SBP and relative resistance was the highest in the thoracic segment (−0.33 [−0.432 to −0.219], p < 0.001) and the lowest for whole body measurements (−0.154 [−0.269 to −0.036], p = 0.01). In addition, multiple regression analysis indicated thoracic resistance as the best predictor for changes in SBP (β = −0.261 [−0.353 to −0.126], p < 0.001).

Discussion

These findings suggest that the thorax is the most suitable region for segmental bioimpedance measurements to assess hemodynamic parameters. Thoracic bioimpedance may innovate the hemodynamic monitoring of hemodialysis patients.

导言：预防血液透析期间的血流动力学并发症仍然具有挑战性。尽管全身生物阻抗在流体状态评估中已经很好地建立起来，但它在动态或连续记录中的应用是有限的。分段方法可以更好地达到这一目的。本研究探讨了血液动力学监测中哪个身体部位最适合测量生物阻抗。方法：在这项观察性研究中，对15例患者在两次血液透析期间的全身、小腿、上臂和胸部进行了一系列生物阻抗测量。利用生物阻抗的阻力分量来研究容积和收缩压（SBP）变化的关系。结果：透析前和透析后两个阶段的相对阻力变化显示，上臂的类内相关系数最低（0.023），胸廓阻力最高（0.728）。上臂和胸椎段的超滤体积和相对阻力的相关性可比较（0.538[0.447-0.618]和0.537[0.446-0.617]）。讨论：这些发现表明胸部是最适合进行节段性生物阻抗测量以评估血流动力学参数的区域。胸廓生物阻抗可能革新血液透析患者的血流动力学监测。

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引用次数: 0

The Long-Term Patency Rate and Factors Influencing Dysfunction of the Autogenous Arteriovenous Fistula in Hemodialysis Patients: A Retrospective Study 血透患者自体动静脉瘘长期通畅率及功能障碍影响因素的回顾性研究。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-24 DOI: 10.1111/hdi.13246

Qinghua He, Yu Zhou, Chen Chen, Baojia Zheng, Jingjing Zhang, Fulan Wang

Introduction

Autogenous arteriovenous fistula (AV fistula) dysfunction continues to be a widespread clinical challenge, adversely impacting both patients and society as a whole. The aim of this study was to investigate the long-term patency rate of AV fistula, explore the factors that contribute to AV fistula dysfunction, and present the findings in a way that can guide clinical practice.

Methods

This retrospective cohort study enrolled patients who underwent AV fistula creation and subsequent hemodialysis at a tertiary A-level hospital in Chongqing, China. Demographic, clinical, and laboratory characteristics of the patients, as well as AV fistula dysfunction, were retrospectively reviewed from electronic health records. Cox proportional hazards regression analysis was used to analyze the factors influencing AV fistula dysfunction, and a forest plot was created to visualize the results. Additionally, Kaplan–Meier survival analysis was used to analyze AV fistula survival.

Findings

This study analyzed 226 patients undergoing hemodialysis, demonstrating cumulative AV fistula patency rates of 82.1% at 12 months, 60.7% at 36 months, 45.4% at 60 months, and 33.5% at 84 months. Univariate Cox proportional hazard regression analysis identified six variables associated with AV fistula dysfunction (p < 0.1): body mass index (BMI), preemptive AV fistula creation, diabetes, total cholesterol, albumin, and uric acid. Subsequent multivariate analysis revealed four independent predictors for dysfunction: elevated BMI (HR: 1.58, p = 0.016), preemptive AV fistula creation (HR: 0.67, p = 0.029), albumin (HR: 2.83, p < 0.001), and uric acid (HR: 1.57, p = 0.020).

Discussion

Our study findings indicated that overweight, hypoalbuminemia, and high concentrations of uric acid were independent risk factors for AV fistula dysfunction. In contrast, preemptive AV fistula creation was an independent protective factor against AV fistula dysfunction. Therefore, early interventions and surveillance for these factors should be performed to improve long-term AV fistula patency rates.

自体动静脉瘘（AV瘘）功能障碍一直是一个广泛的临床挑战，对患者和整个社会都有不利影响。本研究的目的是调查房瘘的长期通畅率，探讨导致房瘘功能障碍的因素，并提出研究结果以指导临床实践。方法：本回顾性队列研究纳入了在中国重庆某三级甲等医院行房内瘘造瘘和血液透析的患者。从电子健康记录中回顾性回顾了患者的人口统计学、临床和实验室特征以及房室瘘功能障碍。采用Cox比例风险回归分析影响房室瘘功能障碍的因素，并制作森林图将结果可视化。此外，Kaplan-Meier生存分析用于分析房室瘘的生存。研究结果：该研究分析了226例接受血液透析的患者，显示12个月时累积房室瘘通畅率为82.1%，36个月时为60.7%，60个月时为45.4%，84个月时为33.5%。单因素Cox比例风险回归分析确定了与房室瘘功能障碍相关的6个变量(p讨论：我们的研究结果表明，超重、低白蛋白血症和高浓度尿酸是房室瘘功能障碍的独立危险因素。相比之下，先发制人的房室瘘创建是防止房室瘘功能障碍的独立保护因素。因此，应该对这些因素进行早期干预和监测，以提高长期房瘘通畅率。

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引用次数: 0

Delayed Massive Hemothorax Induced by Tunneled Dialysis Catheter Placement via the Left Internal Jugular Vein: A Case Report 经左颈内静脉放置隧道式透析导管致迟发性大量血胸1例。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-13 DOI: 10.1111/hdi.13244

Ping Shi, Mengyue Zhu, Yi Zhang, Jun Xu, Hongbin Mou

The tunneled dialysis catheter is among the most commonly used vascular accesses for patients undergoing hemodialysis. Delayed hemothorax resulting from central venous perforation induced by catheterization is a rare but serious complication. However, there are few reports. This article reports the case of a 79-year-old male who developed delayed massive hemothorax following catheter placement via the left internal jugular vein. The condition was successfully managed with closed thoracostomy and conservative therapy. This case underscores the potential for delayed hemothorax after tunneled dialysis catheter placement, emphasizing the need for heightened vigilance during the immediate post-procedural period. Close monitoring in the first hours after catheterization is critical to enable early detection, prompt recognition, and timely intervention for such complications.

隧道式透析导管是血液透析患者最常用的血管通路之一。中心静脉穿刺引起的迟发性血胸是一种罕见但严重的并发症。然而，鲜有报道。本文报告一名79岁男性，经左颈内静脉置管后发展为迟发性大量血胸。通过闭式开胸术和保守治疗，成功地控制了病情。本病例强调了放置隧道透析导管后迟发性血胸的可能性，强调了在手术后立即提高警惕的必要性。在置管后的最初几个小时内密切监测对于早期发现、及时识别和及时干预此类并发症至关重要。

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