Malovrh Marko
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana - Slovenia.
J Vasc Access. 2015;16 Suppl 9:S20-3. doi: 10.5301/jva.5000332. Epub 2015 Mar 8.
The long-term survival and quality of life of patients on hemodialysis is dependent on the adequacy of dialysis via an appropriately placed vascular access. Recent clinical practice guidelines recommend the creation of native arteriovenous fistula or synthetic graft before start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. The direct involvement of nephrologists in the management of referral patterns, predialysis follow-up, policy of venous preservation, preoperative evaluation, vascular access surgery and vascular access care seems to be important and productive targets for the quality of care delivered to the patients with end-stage renal disease. Early referral to nephrologists is important for delay progression of both kidney disease and its complications by specific and adequate treatment, for education program which should include modification of lifestyle, medication management, selection of treatment modality and instruction for vein preservation and vascular access. Nephrologists are responsible for on-time placement and adequate maturation of vascular access. The number of nephrologists around the world who create their own fistulas and grafts is growing, driven by a need for better patient outcomes on hemodialysis. Nephrologists have also a key role for care of vascular access during hemodialysis treatment by following vascular access function using clinical data, physical examination and additional ultrasound evaluation. Timely detection of malfunctioning vascular access means timely surgical or radiological intervention and increases the survival of vascular access.
血液透析患者的长期生存和生活质量取决于通过适当放置的血管通路进行充分的透析。最近的临床实践指南建议在开始慢性血液透析治疗之前建立自体动静脉内瘘或人工血管移植物，以避免使用易引发并发症的透析导管。肾病学家直接参与转诊模式管理、透析前随访、静脉保护策略、术前评估、血管通路手术及血管通路护理，这对于为终末期肾病患者提供的医疗质量而言，似乎是重要且富有成效的目标。早期转诊至肾病学家处，对于通过特定且充分的治疗延缓肾病及其并发症的进展很重要，对于教育计划也很重要，该计划应包括生活方式的改变、药物管理、治疗方式的选择以及静脉保护和血管通路的指导。肾病学家负责及时放置血管通路并使其充分成熟。受血液透析患者获得更好治疗效果需求的推动，全球自行创建内瘘和移植物的肾病学家数量正在增加。肾病学家在血液透析治疗期间对血管通路的护理中也起着关键作用，即通过临床数据、体格检查及额外的超声评估来跟踪血管通路功能。及时检测血管通路故障意味着及时进行外科或放射介入，并提高血管通路的存活率。
