Okamoto Takeshi, Sakurada Tsutomu, Koitabashi Kenichiro, Shibagaki Yugo
Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
Hemodial Int. 2018 Oct;22(S2):S3-S9. doi: 10.1111/hdi.12697. Epub 2018 Oct 26.
As the number of elderly end-stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs.
This single-center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early- and late-phase groups) based on the median observational period. Demographic data and clinical information were then compared.
Fifty TCCs were inserted in the early phase group, and 93 TCCs were inserted in the late-phase group. The late-phase group was older (77 vs. 70 years; P = 0.003) and showed a higher frequency of hypertensive nephropathy (29% vs. 14%; P < 0.05) and a lower frequency of a history of cardiovascular disease (52.7% vs. 70.0%; P = 0.045). In the late-phase group, indications for bridge vascular access (0% vs. 11.8%; P < 0.05) or severe cardiac dysfunction (8.0% vs. 20.5%; P < 0.05) were increased. In addition, the late-phase group showed increases in percentage of patients with the catheter inserted in the femoral vein (10.0% vs. 23.7%; P = 0.047), nephrologists performing catheter insertion (56.0% vs. 87.1%; P < 0.001), and the patients who underwent superficialization of the brachial artery (28.0% vs. 46.2%; P = 0.034). Significant differences in catheter survival, incidence of complications, reasons for catheter removal, or incidence of catheter-related infection were not observed between groups.
Patients with indications for TCC may be increasing due to an increase in elderly end-stage renal disease patients whose activities of daily living have decreased. In addition, indications for bridge vascular access were widely accepted in the late-phase group.
随着缺乏适合动静脉内瘘（AVF）血管的老年终末期肾病患者数量不断增加，隧道带 cuff 导管（TCC）的适应证可能正在扩大。本研究旨在阐明 TCC 患者数量及 TCC 适应证随时间的变化情况。
这项单中心回顾性研究分析了 2005 年 7 月至 2017 年 7 月期间 95 例插入 TCC 的患者的 143 根导管。根据观察期的中位数将患者分为两组（早期组和晚期组）。然后比较人口统计学数据和临床信息。
早期组插入了 50 根 TCC，晚期组插入了 93 根 TCC。晚期组患者年龄更大（77 岁对 70 岁；P = 0.003），高血压肾病的发生率更高（29%对 14%；P < 0.05），心血管疾病史的发生率更低（52.7%对 70.0%；P = 0.045）。在晚期组中，桥接血管通路的适应证（0%对 11.8%；P < 0.05）或严重心脏功能障碍的适应证（8.0%对 20.5%；P < 0.05）有所增加。此外，晚期组中导管插入股静脉的患者百分比增加（10.0%对 23.7%；P = 0.047），由肾病科医生进行导管插入的患者增加（56.0%对 87.1%；P < 0.001），以及接受肱动脉浅表化的患者增加（28.0%对 46.2%；P = 0.034）。两组之间在导管存活、并发症发生率、导管拔除原因或导管相关感染发生率方面未观察到显著差异。
由于日常生活活动能力下降的老年终末期肾病患者数量增加，TCC 适应证患者可能在增多。此外，桥接血管通路的适应证在晚期组中被广泛接受。
