有并发症的隧道式血液透析导管更换策略:全国队列研究。

IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Clinical Journal of the American Society of Nephrology Pub Date : 2024-06-24 DOI:10.2215/CJN.0000000000000495
Benjamin Lazarus, Sradha Kotwal, Martin Gallagher, Nicholas A Gray, Sarah Coggan, Girish Talaulikar, Kevan R Polkinghorne
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引用次数: 0

摘要

背景:隧道式血液透析导管经常出现感染性或机械性并发症,需要意外拔除和更换,但最佳更换策略尚不清楚。本研究描述了澳大利亚两种策略的实际使用情况,并比较了两种策略下插入更换导管的存活率:这项二次分析采用了 REDUCCTION 试验的观察数据,该试验在全国范围内招募了 6400 名接受血液透析导管的成人(2016-2020 年)。隧道式导管的更换方法是通过现有隧道管路更换导管或通过新管路移除并更换导管。通过在 434 例机械隧道导管故障患者中进行假设性实用随机试验,估算了更换策略对因感染或功能障碍而拔除导管的时间的影响:结果:在试验期间插入的 9974 根隧道式血液透析导管中,380 根出现感染并发症,945 根出现需要更换的机械并发症。几乎所有受感染的血液透析导管(97%)都被移除,并通过新的隧道导管单独更换,而肾脏内科在更换机械故障导管的做法上存在很大差异(中位数=50%导丝被更换,四分位间范围=30%-67%)。在对患者因素进行调整后,服务水平差异占剩余差异的 29%。在机械性衰竭的目标试验模拟队列(N=434 例患者)中,导管置换与较低的无并发症存活率(1 个月)无关(1 个月的反事实存活率差异 = 5.9%,95% CI = -2%,14%):结论:导管机械故障的导丝更换与导管存活率降低无关,对患者来说可能更可取。
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Replacement Strategies for Tunneled Hemodialysis Catheters with Complications: A Nationwide Cohort Study.
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来源期刊
CiteScore
12.20
自引率
3.10%
发文量
514
审稿时长
3-6 weeks
期刊介绍: The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.
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