Kabinga Samuel K, Kayima Joshua K, McLigeyo Seth O, Ndungu John N
East African Kidney Institute, University of Nairobi, Nairobi, Kenya.
Renal Department, Kenyatta National Hospital, Nairobi, Kenya.
J Vasc Access. 2019 Nov;20(6):697-700. doi: 10.1177/1129729819845571. Epub 2019 May 6.
The objective of our study was to document the level of preparedness for renal replacement therapy assessed by incident hemodialysis vascular access and the access at least 3 months after initiation of hemodialysis at Kenyatta National Hospital, Nairobi.
Between June and July 2018, we carried out a cross-sectional descriptive study on the preparedness for hemodialysis by patients who were on chronic hemodialysis in the Kenyatta National Hospital Renal Department. Sociodemographic, medical history, duration of follow-up, and state of preparedness parameters were obtained through interview and entered into the questionnaire. The data were entered in preprogrammed format in the Statistical Package for the Social Sciences (SPSS) version 20.0 for analyses.
Eighty-two patients were enrolled. Males were 50% (41). The mean age was 45.39 ± 15.96 years but females were 5 years younger than their male counterparts. About 85.4% of the patients were drawn from the hypertension and diabetes clinics, and the mean, mode, and median of the duration of follow-up were 41, 0, and 0 months, respectively, in these clinics. Almost three in every four patients (74.4%) were initiated on hemodialysis as emergency (p value < 0.001). About 80% were initiated hemodialysis via acute catheters placed in the jugular and subclavian veins (p value < 0.001). At least 3 months later, 40% still had acute catheters on the same veins (p value < 0.001). Acute venous catheters in the femoral veins were in 9.2% at initiation and 6.6% of the patients at least 3 months later. Less than 2% of the patients had arteriovenous fistulae at initiation, which rose to 14.5% in 3 months. Tunneled catheters were placed in 11.8% initially and at least 3 months, were almost in 40% of the patients.
In conclusion, our young hemodialysis population mainly drawn from hypertension and diabetes clinic requires more input in hemodialysis vascular access planning. Focused individualized follow-up and early referrals to nephrologists are required. Uptake of arteriovenous grafts for hemodialysis might reduce the prevalence of hemodialysis catheters. As it is, this population is threatened with iterative vascular accesses complications as well as real danger of exhaustion of their vascular capital. There is real danger of increase in mortality from access complications.
我们研究的目的是记录内罗毕肯雅塔国家医院通过首次血液透析血管通路以及血液透析开始至少3个月后的通路来评估的肾脏替代治疗准备水平。
2018年6月至7月期间，我们对肯雅塔国家医院肾脏科接受慢性血液透析的患者的血液透析准备情况进行了横断面描述性研究。通过访谈获取社会人口统计学、病史、随访时间和准备状态参数，并录入问卷。数据以预编程格式录入社会科学统计软件包（SPSS）20.0版进行分析。
共纳入82例患者。男性占50%（41例）。平均年龄为45.39±15.96岁，但女性比男性小5岁。约85.4%的患者来自高血压和糖尿病门诊，这些门诊患者的随访时间均值、众数和中位数分别为41、0和0个月。几乎每四名患者中就有三名（74.4%）作为急诊开始血液透析（p值<0.001）。约80%的患者通过置于颈静脉和锁骨下静脉的急性导管开始血液透析（p值<0.001）。至少3个月后，40%的患者仍在同一静脉留置急性导管（p值<0.001）。开始时股静脉急性静脉导管置入率为9.2%，至少3个月后为6.6%。开始时不到2%的患者有动静脉内瘘，3个月后升至14.5%。开始时11.8%的患者置入了带隧道的导管，至少3个月后，近40%的患者仍有。
总之，我们以高血压和糖尿病门诊患者为主的年轻血液透析人群在血液透析血管通路规划方面需要更多投入。需要进行有针对性的个体化随访并尽早转诊至肾病科医生。采用动静脉移植物进行血液透析可能会降低血液透析导管的患病率。照目前情况来看，这群人面临着反复出现的血管通路并发症以及血管资源耗尽的实际危险。因通路并发症导致死亡率增加的实际风险确实存在。
