Department of Medicine, Hopital du Sacré-Coeur de Montréal, Montreal, Canada.
Department of Medical Biology, Hopital du Sacre-Coeur de Montreal, Montreal, Canada.
Nephrol Dial Transplant. 2017 Apr 1;32(4):699-706. doi: 10.1093/ndt/gfw456.
Extracorporeal treatments (ECTRs) are used for different conditions, including replacement of organ function and poisoning. Current recommendations for ECTRs in various poisonings suggest that intermittent haemodialysis (IHD) is the most efficient technique. However, the practicality of these recommendations is poorly defined in view of limited information on availability and cost worldwide.
A survey invitation to an Internet-based questionnaire was emailed between January 2014 and March 2015 to members of international societies to determine the availability, time to initiation and cost of ECTRs (including filters, dialysate, catheter, anticoagulant and nursing/physician salary). The median cost ratio of every ECTR compared with IHD performed in the same institution were presented.
The view rate was estimated at 28.1% (2532/9000), the participation rate was 40.1% (1015/2532) and the completion rate was 16.0% (162/1015). Respondents originated from 89 countries, and nearly three-fourths practiced in a tertiary care centre. A total of 162 respondents provided sufficient data for in-depth analysis. IHD was the most available acute ECTR (96.9%), followed by therapeutic plasma exchange (TPE; 68.3%), continuous renal replacement therapy (CRRT; 62.9%), peritoneal dialysis (PD; 44.8%), haemoperfusion (HP; 30.9%) and liver support devices (LSDs; 14.7%). IHD, CRRT and HP were the shortest to initiate (median = 60 min). The median cost ratios of each ECTR compared with IHD were 1.7 for CRRT and HP, 2.8 for TPE, 6.5 for LSDs and 1.4 for PD (P < 0.001 for all). The median cost ratio of a 4-h IHD treatment compared with 1 day in the intensive care unit was 0.6 (P = 0.2).
IHD appears to be the most widely available ECTR worldwide and is at least 30% less expensive than other ECTRs. The superior efficacy of IHD for enhanced elimination, added to its lower cost and wider availability, strengthens its preference as the ECTR of choice in most cases of acute poisoning.
costing, CRRT, EXTRIP, hemodialysis, hemoperfusion.
体外治疗（ECTR）用于多种病症，包括器官功能替代和中毒。目前，针对各种中毒的 ECTR 推荐意见表明，间歇性血液透析（IHD）是最有效的技术。然而，鉴于全球范围内关于可用性和成本的信息有限，这些推荐意见的实用性尚不清楚。
2014 年 1 月至 2015 年 3 月期间，通过电子邮件向国际学会成员发送了一份互联网问卷调查邀请，以确定 ECTR（包括过滤器、透析液、导管、抗凝剂和护理/医生工资）的可用性、开始时间和成本。提出了每种 ECTR 与在同一机构进行的 IHD 相比的成本比值中位数。
预计查看率为 28.1%（2532/9000），参与率为 40.1%（1015/2532），完成率为 16.0%（162/1015）。回复者来自 89 个国家，近四分之三的人在三级护理中心工作。共有 162 名回复者提供了足够的数据进行深入分析。IHD 是最可用的急性 ECTR（96.9%），其次是治疗性血浆置换（TPE；68.3%）、连续肾脏替代治疗（CRRT；62.9%）、腹膜透析（PD；44.8%）、血液灌流（HP；30.9%）和肝脏支持设备（LSD；14.7%）。IHD、CRRT 和 HP 启动时间最短（中位数=60 分钟）。与 IHD 相比，每种 ECTR 的成本比值中位数分别为 CRRT 和 HP 为 1.7，TPE 为 2.8，LSD 为 6.5，PD 为 1.4（均<0.001）。与 ICU 中 4 小时 IHD 治疗相比，1 天的 IHD 治疗的中位成本比值为 0.6（P=0.2）。
IHD 似乎是全球最广泛可用的 ECTR，其成本至少比其他 ECTR 低 30%。IHD 在增强清除方面的优越性，加上其较低的成本和更广泛的可用性，使其成为大多数急性中毒情况下首选的 ECTR。
成本核算、CRRT、EXTRIP、血液透析、血液灌流。
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