Kim Suh Min, Han Ahram, Ahn Sanghyun, Min Sang-Il, Ha Jongwon, Joo Kwon-Wook, Min Seung-Kee
Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Vasc Access. 2019 Nov;20(6):659-665. doi: 10.1177/1129729819838132. Epub 2019 Apr 8.
Current guidelines recommend the placement of vascular access 6 months before the anticipated start of hemodialysis therapy; however, many patients start hemodialysis using a central venous catheter. We investigated the timing of referral for vascular access, the vascular access type at hemodialysis initiation, and the barriers to a timely referral.
The study involved a retrospective review of 237 patients for whom the first vascular access for hemodialysis was created between January and November 2017.
Among the 237 patients, 58.2% were referred before hemodialysis initiation, while 41.8% were referred after hemodialysis initiation. Among the 138 patients, 55, 59, and 24 patients were referred more than 6 months, between 2 and 6 months, and within 2 months before hemodialysis initiation, respectively. Within these subgroups, 3.6%, 10.2%, and 75.0% patients underwent hemodialysis initiation with a central venous catheter, respectively. Among the 99 patients referred after hemodialysis initiation, the reasons for late referral were as follows: unexpected rapid progression of kidney disease (n = 23), noncompliance (n = 21), late visit to the nephrologist (initial visit within 2 months of hemodialysis initiation; n = 14), change of treatment strategy from peritoneal dialysis or transplants (n = 9), and unknown reasons (n = 32).
Only 23% of patients were referred for vascular access 6 months before the anticipated hemodialysis therapy. In addition, 53% of patients initiated hemodialysis with a central venous catheter. Avoidance of catheter insertion was mostly successful in patients referred 2 months before hemodialysis initiation. The most common modifiable barrier to the timely referral was noncompliance.
当前指南建议在预期开始血液透析治疗前6个月建立血管通路；然而，许多患者开始血液透析时使用的是中心静脉导管。我们调查了血管通路转诊的时机、血液透析开始时的血管通路类型以及及时转诊的障碍。
该研究回顾性分析了237例在2017年1月至11月期间首次建立血液透析血管通路的患者。
在这237例患者中，58.2%在血液透析开始前被转诊，而41.8%在血液透析开始后被转诊。在138例在血液透析开始前被转诊的患者中，分别有55例、59例和24例在血液透析开始前6个月以上、2至6个月以及2个月内被转诊。在这些亚组中，分别有3.6%、10.2%和75.0%的患者开始血液透析时使用中心静脉导管。在99例在血液透析开始后被转诊的患者中，延迟转诊的原因如下：肾病意外快速进展（n = 23）、不依从（n = 21）、肾病科医生就诊延迟（血液透析开始后2个月内首次就诊；n = 14）、治疗策略从腹膜透析或移植改变（n = 9）以及原因不明（n = 32）。
只有23%的患者在预期血液透析治疗前6个月被转诊进行血管通路建立。此外，53%的患者开始血液透析时使用中心静脉导管。在血液透析开始前2个月被转诊的患者中，避免插入导管大多是成功的。及时转诊最常见的可改变障碍是不依从。
