Aragon Michael Alexander, El Shamy Osama, Zheng Sijie, Chertow Glenn M, Glickman Joel, Weinhandl Eric, Komenda Paul, Dunning Stephan, Liu Frank, Lok Charmaine
Outset Medical, San Jose, CA.
Division of Renal Disease and Hypertension, Department of Medicine, George Washington University, Washington, DC.
Kidney Med. 2024 Oct 15;7(1):100916. doi: 10.1016/j.xkme.2024.100916. eCollection 2025 Jan.
Expansion of home hemodialysis (HHD) provides an opportunity to improve clinical outcomes, reduce cost of care, and address the staffing challenges currently faced in caring for patients with kidney failure on replacement therapy. To increase HHD expansion, current practices and barriers to home dialysis must be examined and addressed. One such barrier is vascular access for HHD; although tunneled hemodialysis central venous catheters (CVCs) have been used for decades, physicians still hesitate to send patients home without a mature, functional arteriovenous access. An expert panel of clinicians was convened by Outset Medical, a manufacturer of hemodialysis systems, to review the literature and generate consensus recommendations regarding the use of CVCs for HHD. Consistent with the most recent Kidney Disease Outcomes vascular access guidelines, the end-stage kidney disease life plan should be created via shared decision making for modality choices, with the corresponding dialysis access individualized for the patient, and for whom a CVC may represent the most appropriate vascular access to provide HHD.
扩大家庭血液透析（HHD）提供了一个改善临床结局、降低护理成本以及应对目前在为接受替代治疗的肾衰竭患者提供护理时所面临的人员配备挑战的机会。为了扩大HHD的规模，必须审视并解决家庭透析的当前做法和障碍。这样一个障碍就是HHD的血管通路；尽管隧道式血液透析中心静脉导管（CVC）已经使用了几十年，但医生在没有成熟、功能正常的动静脉通路的情况下，仍会犹豫是否将患者送回家。血液透析系统制造商Outset Medical召集了一个临床医生专家小组，以回顾文献并就HHD中CVC的使用制定共识性建议。与最新的肾脏疾病结局血管通路指南一致，终末期肾病生活计划应通过关于透析方式选择的共同决策来制定，相应的透析通路应根据患者个体情况进行定制，对于某些患者而言，CVC可能是提供HHD的最合适的血管通路。
