Asif Arif, Salman Loay, Lopera Gustavo, Haqqie Syed S, Carrillo Roger
Interventional Nephrology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Semin Dial. 2012 Sep-Oct;25(5):582-6. doi: 10.1111/j.1525-139X.2012.01053.x. Epub 2012 Feb 22.
Abnormal renal function is an independent risk factor for cardiac implantable electronic device (CIED) infection. The risk of CIED infection increases as the degree of renal dysfunction worsens with the highest risk observed in patients with stage V chronic kidney disease. A significant portion of these patients use a tunneled hemodialysis catheter (TDC) for dialysis therapy. These devices are associated with very high rates of catheter-related bacteremia (1.6-5.5 episodes of bacteremia per 1000 catheter days), and have been known to cause infection of CIED indwelling in the bloodstream. In this context, the cardiac device is exposed to the risk of infection due to the presence of renal failure and episodes of bacteremia related to TDCs. Both increase the risk of CIED infection. Once infected, a cardiac rhythm device carries a marked increase in morbidity and mortality. In this context, the combination of a TDC and a CIED indwelling in the bloodstream becomes a potentially deadly combination. Recent data have emphasized that epicardial CIED implantation reduces cardiac device infection in TDC patients. This report highlights the risk of CIED infection in renal patients, presents TDC's contribution to the cardiac device infection, and suggests recommendations to minimize the risk of CIED infection in chronic hemodialysis patients dialyzing with a TDC.
肾功能异常是心脏植入式电子设备（CIED）感染的独立危险因素。随着肾功能不全程度的加重，CIED感染风险增加，其中V期慢性肾脏病患者的风险最高。这些患者中有很大一部分使用带隧道的血液透析导管（TDC）进行透析治疗。这些设备与极高的导管相关菌血症发生率相关（每1000导管日发生1.6 - 5.5次菌血症），并且已知会导致血流中CIED感染。在这种情况下，由于存在肾衰竭以及与TDC相关的菌血症发作，心脏设备面临感染风险。这两者都会增加CIED感染的风险。一旦感染，心脏节律设备的发病率和死亡率会显著增加。在这种情况下，TDC与血流中留置的CIED相结合成为一种潜在的致命组合。最近的数据强调，心外膜CIED植入可降低TDC患者的心脏设备感染率。本报告强调了肾病患者发生CIED感染的风险，介绍了TDC对心脏设备感染的影响，并提出了将使用TDC进行慢性血液透析患者的CIED感染风险降至最低的建议。
