Asif Arif, Besarab Anatole, Roy-Chaudhury Prabir, Spergel Lawrence M, Ravani Pietro
Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
J Nephrol. 2007 Jul-Aug;20(4):399-405.
In recent years, nephrologists have taken the initiative of performing vascular access-related procedures themselves. Because of their unique clinical perspective on dialysis access and better understanding of the intricacies of renal replacement therapy, nephrologists are ideally suited for this activity. This approach has minimized delays, decreased hospitalizations and decreased the use of temporary catheters, thereby improving medical care, decreasing costs and increasing patient convenience. Vascular access interventions commonly employed by nephrologists include vascular access education, vascular mapping, percutaneous balloon angioplasty, thrombectomy, intravascular coil and stent insertion and tunneled hemodialysis catheter-related procedures. While the performance of these procedures by nephrologists offers many advantages, appropriate training to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated the safety and success of an interventional nephrology approach. The last decade has been a period of significant advances in this new field. This has been driven in part by the formation of the American Society of Diagnostic and Interventional Nephrology (ASDIN), whose mission includes training, quality assurance and certification. Recently, the ASDIN has published guidelines for training in nephrology-related procedures and has begun certifying physicians in specific procedures related to chronic kidney disease. It is anticipated that this will promote the skillful performance of these procedures by nephrologists and lead to substantial improvements in the care of renal patients. Challenges for the future include awareness of this subspecialty and development of training programs at academic centers on a larger scale.
近年来，肾病学家已主动自行开展与血管通路相关的操作。由于他们对透析通路有着独特的临床视角，且对肾脏替代治疗的复杂性有更深入的了解，肾病学家非常适合开展这项工作。这种方法减少了延误，降低了住院率，减少了临时导管的使用，从而改善了医疗护理，降低了成本，提高了患者的便利性。肾病学家常用的血管通路干预措施包括血管通路教育、血管造影、经皮球囊血管成形术、血栓切除术、血管内线圈和支架置入以及隧道式血液透析导管相关操作。虽然肾病学家开展这些操作有诸多优势，但进行适当培训以培养必要的操作技能至关重要。近期数据强调，肾病学家可以通过成功培训成为称职的介入专家。除了有出色的疗效数据记录外，多项报告还证明了介入肾病学方法的安全性和成功率。过去十年是这个新领域取得重大进展的时期。这在一定程度上得益于美国诊断与介入肾病学会（ASDIN）的成立，其使命包括培训、质量保证和认证。最近，ASDIN发布了肾病相关操作的培训指南，并已开始对与慢性肾脏病相关的特定操作的医生进行认证。预计这将促进肾病学家熟练开展这些操作，并大幅改善肾病患者的护理。未来的挑战包括提高对这一亚专业的认识以及在学术中心更大规模地开展培训项目。
