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短期血液透析与腹膜透析置管期间出血风险的关联

Association Between Transient Hemodialysis and Risk of Bleeding During Peritoneal Dialysis Catheterization.

作者信息

Kim A Young, Cho Kyu Hyang, Park Jong Won, Do Jun Young, Kang Seok Hui

机构信息

Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea.

出版信息

J Clin Med. 2024 Nov 27;13(23):7188. doi: 10.3390/jcm13237188.

Abstract

: Although the risk of serious bleeding following peritoneal dialysis catheter insertion is low, pericannular bleeding can increase the risk of catheter-related infections and reduce catheter survival. We aimed to analyze the risk factors for bleeding complications during peritoneal dialysis catheter insertion and assess whether temporary preemptive hemodialysis before catheterization can reduce bleeding and improve catheter survival. : We retrospectively analyzed bleeding complications and catheter survival in patients who underwent temporary hemodialysis prior to peritoneal dialysis catheter insertion. Cox regression analysis was performed to determine the risk factors for bleeding complications and catheter survival. : Among 336 patients, 216 and 120 comprised the non-hemodialysis and hemodialysis groups, respectively. No significant association was found between temporary hemodialysis and bleeding (hazard ratio: 1.6, 95% confidence interval: 0.87-2.95, < 0.134). Multivariate analysis revealed an inverse association of platelet count (hazard ratio: 0.99, 95% confidence interval: 0.99-0.99, < 0.048) and hemoglobin level (hazard ratio: 0.78, 95% confidence interval: 0.61-0.99, < 0.04) with bleeding. A positive association was observed between international normalized ratio (hazard ratio: 2.24, 95% confidence interval: 1.19-4.19, < 0.012) and bleeding. Conversely, temporary hemodialysis was not associated with catheter survival (hazard ratio: 1.64, 95% confidence interval: 0.63-4.25, < 0.308). : Temporary hemodialysis before peritoneal dialysis catheter insertion did not significantly affect bleeding risk in patients with a high risk of uremic bleeding.

摘要

虽然腹膜透析导管插入术后严重出血的风险较低,但导管周围出血会增加导管相关感染的风险并缩短导管使用寿命。我们旨在分析腹膜透析导管插入术期间出血并发症的危险因素,并评估插管前进行临时预防性血液透析是否可以减少出血并提高导管使用寿命。

我们回顾性分析了在腹膜透析导管插入术前接受临时血液透析的患者的出血并发症和导管使用寿命。进行Cox回归分析以确定出血并发症和导管使用寿命的危险因素。

在336例患者中,非血液透析组和血液透析组分别有216例和120例。临时血液透析与出血之间未发现显著关联(风险比:1.6,95%置信区间:0.87 - 2.95,P < 0.134)。多变量分析显示血小板计数(风险比:0.99,95%置信区间:0.99 - 0.99,P < 0.048)和血红蛋白水平(风险比:0.78,95%置信区间:0.61 - 0.99,P < 0.04)与出血呈负相关。国际标准化比值与出血呈正相关(风险比:2.24,95%置信区间:1.19 - 4.19,P < 0.012)。相反,临时血液透析与导管使用寿命无关(风险比:1.64,95%置信区间:0.63 - 4.25,P < 0.308)。

腹膜透析导管插入术前进行临时血液透析对有高风险尿毒症出血的患者的出血风险没有显著影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b2f/11642146/b6496b6d53ef/jcm-13-07188-g001.jpg

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