Hussein Wael F, Mohammed Husham, Browne Leonard, Plant Liam, Stack Austin G
Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland.
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
BMC Nephrol. 2018 Apr 2;19(1):76. doi: 10.1186/s12882-018-0873-x.
Central venous catheters (CVC) are associated with substantial morbidity and mortality among patients undergoing haemodialysis (HD), yet they are frequently used as the primary vascular access for many patients on HD. The goal of this study was to determine the prevalence and variation in CVC use across centres in the Irish health system.
Data from the National Kidney Disease Clinical Patient Management System (KDCPMS) was used to determine CVC use and patterns across centres. Data on demographic characteristics, primary cause of end-stage kidney disease (ESKD), comorbid conditions, laboratory values and centre affiliation were extracted for adult HD patients (n = 1, 196) who were on dialysis for at least three months up to end of December 2016. Correlates of CVC use were explored using multivariable logistic regression.
Overall prevalence of CVC use was 54% and varied significantly across clinical sites from 43% to 73%, P < 0.001. In multivariate analysis, the likelihood of CVC use was lower with increasing dialysis vintage, OR 0.40 (0.26-0.60) for 4 years vs 1 year vintage, rising serum albumin, OR 0.73 (0.59-0.90) per 5 g/L), and with cystic disease as a cause of ESKD, OR 0.38 (95% CI 0.21-0.6). In contrast, catheter use was greater for women than men, OR 1.77 (1.34-2.34) and for 2 out of 10 regional dialysis centres, OR 1.98 (1.02-3.84) and OR 2.86 (1.67-4.90) respectively compared to referent group).
Catheters are the predominant type of vascular access in patients undergoing HD in the Irish health system. Substantial centre variation exists which is not explained by patient-level characteristics.
中心静脉导管（CVC）与接受血液透析（HD）的患者的高发病率和死亡率相关，但它们经常被用作许多HD患者的主要血管通路。本研究的目的是确定爱尔兰卫生系统各中心CVC使用的患病率和差异。
使用来自国家肾脏疾病临床患者管理系统（KDCPMS）的数据来确定各中心CVC的使用情况和模式。提取了截至2016年12月底接受透析至少三个月的成年HD患者（n = 1196）的人口统计学特征、终末期肾病（ESKD）的主要病因、合并症、实验室值和中心所属关系数据。使用多变量逻辑回归探索CVC使用的相关因素。
CVC使用的总体患病率为54%，各临床地点差异显著，从43%到73%不等，P < 0.001。在多变量分析中，随着透析时间的增加，使用CVC的可能性降低，透析4年与1年相比，比值比（OR）为0.40（0.26 - 0.60），血清白蛋白升高，每5 g/L的OR为0.73（0.59 - 0.90），以及以囊性疾病作为ESKD的病因时，OR为0.38（95%置信区间0.21 - 0.6）。相比之下，女性使用导管的比例高于男性，OR为1.77（1.34 - 2.34），在10个区域透析中心中的2个，与参照组相比，OR分别为1.98（1.02 - 3.84）和2.86（1.67 - 4.90）。
在爱尔兰卫生系统中，导管是接受HD患者的主要血管通路类型。存在显著的中心差异，而患者层面的特征无法解释这种差异。
