Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
J Vasc Interv Radiol. 2009 Dec;20(12):1578-81; quiz 1582. doi: 10.1016/j.jvir.2009.08.014.
Nontunneled hemodialysis catheters (NTDCs) are widely used for initial hemodialysis access in new-onset renal failure. The National Kidney Foundation recommends NTDC use for hemodialysis duration of less than 1 week in acute kidney injury because of the increased infection risk compared with tunneled hemodialysis catheters (TDCs) with longer use. The present study was performed to determine whether primary placement of TDCs in this setting is more appropriate, and whether there are predictors of recovery of renal function in less than 1 week.
In the authors' practice, patients referred to the interventional radiology unit in whom no contraindications exist receive a TDC; 76 patients who received a primary TDC for acute kidney injury and who eventually recovered renal function were retrospectively reviewed herein. Causes of renal failure, various renal function parameters, and demographics were collected, as were TDC dwell times, in an effort to determine predictors of recovery and/or extended duration of use.
Mean TDC dwell time in patients who eventually recovered from acute kidney injury was 34 days; only 15 of 76 (20%) recovered within 1 week. At TDC placement, there were no significant differences between patients who recovered in less than (vs greater than) 1 week.
The present results support primary placement of TDCs in patients with acute kidney injury who require hemodialysis and in whom no contraindications exist, as no predictors of recovery of renal function in less than 1 week were identified.
非隧道式血液透析导管（NTDC）广泛用于新发肾衰竭患者的初始血液透析通路。由于与隧道式血液透析导管（TDC）相比，NTDC 的感染风险更高，因此国家肾脏基金会建议在急性肾损伤患者中，NTDC 的使用时间不超过 1 周。本研究旨在确定在这种情况下，是否更适合初次放置 TDC，以及是否存在肾功能在 1 周内恢复的预测因素。
在作者的实践中，对于没有禁忌症的患者，介入放射学部门会为其提供 TDC；本文回顾性分析了 76 例因急性肾损伤而接受初次 TDC 治疗并最终恢复肾功能的患者。收集了肾衰竭的原因、各种肾功能参数和人口统计学数据，以及 TDC 的留置时间，以确定恢复和/或延长使用时间的预测因素。
最终从急性肾损伤中恢复的患者的 TDC 平均留置时间为 34 天；仅有 76 例患者中的 15 例（20%）在 1 周内恢复。在 TDC 放置时，在 1 周内恢复的患者和超过 1 周恢复的患者之间没有显著差异。
本研究结果支持在需要血液透析且无禁忌症的急性肾损伤患者中初次放置 TDC，因为未发现肾功能在 1 周内恢复的预测因素。
