Scott Jemima K, Taylor Dominic M, Dudley Chris R K
Richard Bright Renal Service, North Bristol NHS Trust, UK.
Clin Kidney J. 2018 Apr;11(2):270-274. doi: 10.1093/ckj/sfx090. Epub 2017 Aug 31.
Intravenous drug use is associated with progressive kidney disease of several aetiologies. It is associated with behavioural and lifestyle characteristics that make the provision of renal replacement therapies (RRTs) challenging. We observed that patients who use intravenous drugs [people who inject drugs (PWID)] present late to renal services and struggle to engage with treatment. We describe the experience of a UK centre providing renal services to a mixed city and rural population.
A review of electronic patient records (2003-16) was performed to identify patients actively using intravenous drugs at the time of dialysis initiation. Descriptive statistics were used to describe aetiology, treatment, complications and prognosis.
Twenty-three patients were identified; 15 had a biopsy-proven diagnosis of AA amyloidosis. The median time from presentation to dialysis initiation was 47 days [interquartile range (IQR) 8-147.5]. Hepatitis C infection, venous thromboembolism and mental health disorders were common comorbidities. Eight patients attempted peritoneal dialysis; all failed after a median of 30 days (IQR 21.75-83). One-year survival was 65% (95% confidence interval 42-80), significantly lower than 2013 UK renal registry statistics for incident haemodialysis patients <65 years of age (94.2%).
PWID who develop end-stage kidney disease in our region predominantly have AA amyloidosis. Most present late to renal services and have poor outcomes on all forms of RRT. Rates of transplantation are low. Management challenges include coexisting alcohol and mental health problems, low socio-economic status, contamination of intravenous dialysis access and chaotic lifestyles. Multidisciplinary management with enhanced social support may be beneficial in improving outcomes for this patient group.
静脉吸毒与多种病因导致的进行性肾脏疾病相关。它与一些行为和生活方式特征有关，这使得肾脏替代治疗（RRTs）的提供具有挑战性。我们观察到静脉吸毒患者（注射毒品者）很晚才寻求肾脏服务，并且难以参与治疗。我们描述了英国一个为城市和农村混合人口提供肾脏服务的中心的经验。
对电子病历（2003 - 2016年）进行回顾，以确定在开始透析时正在积极使用静脉毒品的患者。使用描述性统计来描述病因、治疗、并发症和预后。
共识别出23例患者；15例经活检证实诊断为AA型淀粉样变性。从出现症状到开始透析的中位时间为47天[四分位间距（IQR）8 - 147.5]。丙型肝炎感染、静脉血栓栓塞和精神健康障碍是常见的合并症。8例患者尝试腹膜透析；中位30天后均失败（IQR 21.75 - 83）。1年生存率为65%（95%置信区间42 - 80），显著低于2013年英国肾脏登记处<65岁新接受血液透析患者的统计数据（94.2%）。
在我们地区，发展为终末期肾病的注射毒品者主要患有AA型淀粉样变性。大多数患者很晚才寻求肾脏服务，并且在所有形式的RRT上预后都很差。移植率很低。管理挑战包括并存的酒精和精神健康问题、社会经济地位低、静脉透析通路污染以及混乱的生活方式。多学科管理并加强社会支持可能有助于改善该患者群体的预后。
