Tokars J I, Alter M J, Favero M S, Moyer L A, Miller E, Bland L A
Investigation and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333.
ASAIO J. 1994 Oct-Dec;40(4):1020-31.
To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, completed a mail survey of chronic hemodialysis centers in the United States in 1992. Of 2,321 centers surveyed, 2,170 (93%) representing 170,028 patients and 43,535 staff members responded. In 1992, 2,049 (94%) centers used bicarbonate dialysate as the primary method of dialysis, 765 (35)% used high flux dialysis, and 1,569 (72%) reused dialyzers, continuing the trends toward increased use of these methods. Central (subclavian or jugular) venous catheters were used in > or = 1 patient as permanent vascular access for hemodialysis at 69% of dialysis centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence - 0.03%, prevalence = 0.3%). Among centers that had > or = 1 hepatitis B surface antigen positive patient, the incidence of hepatitis B virus infection was lower in those centers that used a separate room for dialysis of patients positive for hepatitis B surface antigen. From 1991 to 1992, reported hepatitis B vaccine coverage increased from 17% to 24% among patients and from 56% to 69% among staff members; in absolute terms, these were the largest single year increases since introduction of hepatitis B vaccine. The prevalence of antibody to hepatitis C virus was 8.1% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 19% of centers and associated with use of high flux dialysis. New dialyzer syndrome was reported by 24% of centers, most frequently by centers using regenerated cellulose or cuprophan membranes. Human immunodeficiency virus was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more patients infected with HIV.
为了确定一些血液透析相关疾病及操作的趋势，疾病控制与预防中心与医疗保健财务管理局合作，于1992年对美国的慢性血液透析中心进行了一项邮件调查。在接受调查的2321个中心中，有2170个（93%）做出了回应，这些中心代表了170028名患者和43535名工作人员。1992年，2049个（94%）中心将碳酸氢盐透析液作为主要透析方法，765个（35%）使用高通量透析，1569个（72%）重复使用透析器，这些方法的使用呈持续增加趋势。69%的透析中心将中心静脉（锁骨下或颈内静脉）导管用于≥1名患者作为血液透析的永久性血管通路。乙肝表面抗原在患者（发病率=0.1%，患病率=1.2%）和工作人员（发病率=0.03%，患病率=0.3%）中的出现频率较低。在有≥1名乙肝表面抗原阳性患者的中心中，为乙肝表面抗原阳性患者使用单独透析室的中心，乙肝病毒感染的发病率较低。从1991年到1992年，报告的乙肝疫苗接种率在患者中从17%升至24%，在工作人员中从56%升至69%；就绝对数字而言，这是自乙肝疫苗推出以来单年增幅最大的。丙肝病毒抗体的患病率在患者中为8.1%，在工作人员中为1.6%。19%的中心报告了在无败血症情况下的发热反应，且与高通量透析的使用有关。24%的中心报告了新透析器综合征，最常见于使用再生纤维素或铜仿膜的中心。已知1.5%的患者感染了人类免疫缺陷病毒；34%的中心报告为1名或多名感染艾滋病毒的患者提供血液透析。
