Lacson E
Fresenius Medical Care-North America, Waltham, MA 02451-1457, USA.
Clin Nephrol. 2011 Jun;75(6):497-505.
Reemergence of the importance of vascular access in the care of the chronic hemodialysis patient has gained prominence due to renewed interest in clinical outcomes and evidence-based interventions. Further fueled by anticipated regulatory changes in the reimbursement for dialysis care in the United States by 2011 and beyond, the drive to improve quality of care for hemodialysis patients has identified vascular access issues as a key contributor to outcomes. Focus has shifted from simply providing any hemodialysis vascular access to a strong preference for the use of native arteriovenous fistulas and subsequently to a need for reducing exposure to central venous catheters. Combined, these goals have forced a reevaluation of the role of arteriovenous grafts. The context and events associated with the evolution of thinking on these issues as well as available data supporting them are discussed. The key leadership role of nephrologists is emphasized along with a summary of problems and proposed solutions.
由于对临床结局和循证干预措施重新产生兴趣，血管通路在慢性血液透析患者护理中的重要性再度凸显。2011年及以后美国透析护理报销预期的监管变化进一步推动了这一趋势，改善血液透析患者护理质量的努力已将血管通路问题确定为影响结局的关键因素。关注点已从单纯提供任何血液透析血管通路，转向强烈倾向使用自体动静脉内瘘，随后又转向需要减少中心静脉导管的使用。综合起来，这些目标促使人们重新评估动静脉移植物的作用。本文将讨论与这些问题相关的思维演变背景和事件，以及支持这些观点的现有数据。文中强调了肾病学家的关键领导作用，并总结了问题及提出的解决方案。
