比较隧道式中心静脉导管和原生动静脉瘘在评估现有血液透析患者死亡率和发病率方面的作用。

Comparison of tunneled central venous catheters and native arteriovenous fistulae by evaluating the mortality and morbidity of patients with prevalent hemodialysis.

机构信息

Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.

出版信息

J Formos Med Assoc. 2019 Apr;118(4):807-814. doi: 10.1016/j.jfma.2018.08.025. Epub 2018 Sep 21.

DOI:10.1016/j.jfma.2018.08.025

PMID:30245144

Abstract

PURPOSE

We examined the association between catheter use for maintenance hemodialysis (HD) and mortality/hospitalization in a cohort of patients with prevalent HD.

METHODS

In this study, 70 HD patients with tunneled cuffed central venous catheters (TCVCs) from a Taiwanese HD center during 2014-2016 were enrolled and compared with 70 matched HD patients with native arteriovenous fistulae (AVF). The compared variables included demographic parameters and laboratory and dialysis-related indices. Cox regression analysis was used to assess the risk of mortality/hospitalization within a year.

RESULTS

Low baseline serum albumin levels were found in patients with TCVCs (3.64 g/dL vs 3.79 g/dL, p = 0.030). The mortality rates of patients with AVF and TCVCs were 14 per 1000 patients and 171 per 1000 patients, respectively. Infection was the leading cause of mortality/hospitalization in patients with TCVCs. Using multivariate analyses, the risk of death was found to be significantly higher in patients with TCVCs than in those with AVF (Hazard ratio [HR] 12.15, 95% CI 1.16-127.17; p = 0.037). Patients with TCVC also had a higher hospitalization rate (HR 1.33, 95% CI 0.71-2.49; p = 0.369) (not statistically significant).

CONCLUSION

Catheter use for maintenance HD was associated with increased all-cause mortality.

摘要

目的

本研究旨在探讨维持性血液透析（HD）患者中使用导管与死亡率/住院率之间的关系。

方法

本研究纳入了 2014-2016 年期间来自台湾某 HD 中心的 70 例使用隧道式带涤纶套中心静脉导管（TCVC）的 HD 患者，并与 70 例匹配的使用自体动静脉瘘（AVF）的 HD 患者进行比较。比较变量包括人口统计学参数、实验室和透析相关指标。使用 Cox 回归分析评估一年内死亡率/住院率的风险。

结果

TCVC 患者的基线血清白蛋白水平较低（3.64 g/dL 比 3.79 g/dL，p=0.030）。AVF 和 TCVC 患者的死亡率分别为每 1000 例患者 14 例和 171 例。感染是 TCVC 患者死亡/住院的主要原因。使用多变量分析，TCVC 患者的死亡风险明显高于 AVF 患者（风险比[HR] 12.15，95%可信区间[CI] 1.16-127.17；p=0.037）。TCVC 患者的住院率也较高（HR 1.33，95% CI 0.71-2.49；p=0.369）（无统计学意义）。