López Gómez J M
Jefe del Servicio de Nefrologia, Hospital Gregorio Maranon, Madrid, Spain.
Nefrologia. 2008;28 Suppl 5:67-70.
SUMMARY In most current hemodialysis (HD) units, two of the most significant problems are vascular access and the steady increase in incident elderly patients. Both are risk factors for morbidity and mortality that require frequent hospitalizations and have a very considerable health cost. The aim of this review is to show the most interesting studies published in 2007 on these two aspects. Regarding vascular access for hemodialysis, a very worrying fact is the progressive increase in incident and prevalent patients dialyzed with a permanent catheter, even though the catheter is a known risk factor of great morbidity and mortality. The dialysis units should have as their goals to reduce the percentage of catheters and to detect early arteriovenous fistulas at risk of thrombosis. In recent years, the incidence of patients of very advanced age is experiencing a notable increase. This type of patients has a high rate of morbidity and mortality. The great challenge for nephrologists is know which patients can really benefit from dialysis treatment. Furthermore, this type of patients have different characteristics than the rest of the general dialysis population, which makes it necessary to adopt different clinical criteria.
摘要 在大多数当前的血液透析（HD）单位中，两个最显著的问题是血管通路和老年患者发病率的稳步上升。这两者都是发病和死亡的危险因素，需要频繁住院，且医疗成本非常高昂。本综述的目的是展示2007年发表的关于这两个方面的最有趣的研究。关于血液透析的血管通路，一个非常令人担忧的事实是，使用永久性导管进行透析的新发病例和现患病例在逐渐增加，尽管导管是一个已知的高发病和高死亡风险因素。透析单位应将减少导管使用比例和早期发现有血栓形成风险的动静脉内瘘作为目标。近年来，高龄患者的发病率显著上升。这类患者的发病率和死亡率很高。肾病学家面临的巨大挑战是要知道哪些患者真正能从透析治疗中获益。此外，这类患者与一般透析人群的其他患者有不同的特征，这使得有必要采用不同的临床标准。
