Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
Hellenic J Cardiol. 2017 Jul-Aug;58(4):276-280. doi: 10.1016/j.hjc.2016.11.023. Epub 2016 Nov 23.
Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT.
We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37.5%; Group A) underwent creation of AVC, and 25 (62.5%; Group B) received intraperitoneal (n=6) or internal jugular catheters (n=19) with the goal of achieving body weight stabilization and relief from congestion.
The characteristics of the two groups were similar. According to Cox regression analysis, the 6-month rate of death or re-hospitalization for HF was significantly higher in Group A (73%) than in Group B (44%); hazard ratio (HR): 2.58; 95% confidence interval (CI) 1.2-6.2; P=0.02. Over a 6-month follow-up, the cumulative survival was significantly shorter (P=0.03) in Group A (13.8±10 weeks) than in Group B (20.7±7 weeks). In the 15 patients who received AVC, the only independent predictor of adverse outcome at 6 months was serum total bilirubin concentration (HR 2.5; 95% CI 1.1-5.7, p=0.02), whereas in the 25 patients who underwent other means of RRT, pulmonary vascular resistance (PVR) was identified as a risk factor for hospitalization or death at 1-year follow-up (HR 1.26; 95% CI 1.1-1.57, p=0.04).
In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion.
慢性间歇性肾脏替代治疗（RRT）是一种针对利尿剂抵抗的终末期心力衰竭（HF）和心肾综合征患者的去充血替代方法。尚未确定最佳的血管通路方法。本研究比较了终末期 HF 患者建立动静脉通路（AVC）与其他 RRT 方式后的 6 个月结局。
我们对 40 例接受慢性间歇性门诊 RRT 的患者进行了治疗，其中 15 例（37.5%；A 组）接受了 AVC 治疗，25 例（62.5%；B 组）接受了腹腔内（n=6）或颈内导管（n=19）治疗，目的是稳定体重和缓解充血。
两组患者的特征相似。根据 Cox 回归分析，A 组（73%）的 6 个月死亡率或 HF 再住院率明显高于 B 组（44%）；风险比（HR）：2.58；95%置信区间（CI）为 1.2-6.2；P=0.02。在 6 个月的随访中，A 组（13.8±10 周）的累积生存率明显短于 B 组（20.7±7 周）（P=0.03）。在接受 AVC 的 15 例患者中，6 个月时不良结局的唯一独立预测因素是血清总胆红素浓度（HR 2.5；95%CI 1.1-5.7，p=0.02），而在接受其他 RRT 方式的 25 例患者中，肺血管阻力（PVR）被确定为 1 年随访时住院或死亡的危险因素（HR 1.26；95%CI 1.1-1.57，p=0.04）。
与安全有效的永久性中心静脉导管放置相比，终末期 HF 患者接受 AVC 间歇性 RRT 治疗后，发病率和死亡率显著增加。PVR 升高的患者似乎构成了中心导管插入后不良结局风险较高的一组。
