Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, 5000 Córdoba, Spain.
Nephrology Service, Reina Sofía University Hospital, 5000 Córdoba, Spain.
Int J Environ Res Public Health. 2021 Jul 16;18(14):7605. doi: 10.3390/ijerph18147605.
Older age and comorbidities in hemodialysis patients determines the use of tunneled catheters as vascular access despite their reported clinical and mortality disadvantages. This prospective matched study analyzes the impact of permanent catheters on inflammation and mortality in hemodialysis patients; We studied 108 patients, 54 with AV-fistula (AVF) and 54 with indwelling hemodialysis catheters (HDC) matched by sex, age, diabetes and time under renal-replacement therapy comparing dialysis efficacy, inflammation and micro-inflammation parameters as well as mortality. Cox-regression analysis was applied to determine predictors of mortality, HDC patients presented higher C-reactive-protein (CRP) blood levels and percentage of pro-inflammatory lymphocytes CD14+/CD16+ with worse dialysis-efficacy parameters. Thirty-six-months mortality appeared higher in the HDC group although statistical significance was not reached. Age with a Hazard Ratio (HR) = 1.06, hypoalbuminemia (HR = 0.43), hypophosphatemia (HR = 0.75) and the increase in CD14+/CD16+ monocyte count (HR = 1.02) were predictors of mortality; elder patients dialyzing through HDC show increased inflammation parameters as compared with nAVF bearing patients, although they do not present a significant increase in mortality when matched by covariates. Increasing age and percentage of pro-inflammatory monocytes as well as decreased phosphate and serum-albumin were predictors of mortality and indicate the main conclusions or interpretations.
老年和合并症患者在血液透析中决定使用隧道导管作为血管通路，尽管它们存在临床和死亡率方面的劣势。这项前瞻性匹配研究分析了永久性导管对血液透析患者炎症和死亡率的影响；我们研究了 108 名患者，54 名动静脉瘘（AVF）患者和 54 名留置血液透析导管（HDC）患者，按性别、年龄、糖尿病和肾脏替代治疗时间进行匹配，比较了透析效果、炎症和微炎症参数以及死亡率。应用 Cox 回归分析确定死亡率的预测因素，HDC 患者的 C 反应蛋白（CRP）血液水平和促炎淋巴细胞 CD14+/CD16+百分比较高，透析效果参数较差。尽管未达到统计学意义，但 HDC 组的 36 个月死亡率似乎较高。年龄的风险比（HR）为 1.06，低白蛋白血症（HR）为 0.43，低磷血症（HR）为 0.75，CD14+/CD16+单核细胞计数增加（HR）为 1.02；与携带 nAVF 的患者相比，通过 HDC 透析的老年患者显示出更高的炎症参数，但在匹配协变量后，死亡率没有显著增加。年龄增加和促炎单核细胞百分比增加以及磷酸盐和血清白蛋白减少是死亡率的预测因素，这些因素表明了主要的结论或解释。
