Beckingham I J, O'Rourke J S, Bishop M C, Blamey R W
Department of Transplant Surgery, City Hospital, Nottingham, UK.
Lancet. 1993 May 29;341(8857):1384-6. doi: 10.1016/0140-6736(93)90951-c.
The rationale for backup fistulae for patients on continuous ambulatory peritoneal dialysis (CAPD) is that many will require emergency haemodialysis and, subsequently, permanent haemodialysis. 42% of renal units in the UK have a policy of providing CAPD patients with backup arteriovenous fistulae. We have investigated whether this policy is justified. In our unit, of 176 patients who started CAPD between 1986 and 1989, most (73%) did not require haemodialysis over a median follow-up period of 4 years. Of the 153 backup fistulae created in 114 patients, only 10 were ever used for emergency haemodialysis. 23 other patients required emergency haemodialysis, but when required their fistulae were no longer functioning. The mean fistula patency times among patients in this study compared very favourably with those in other published work. This finding indicates that most fistulae are not available for emergency haemodialysis when required. 94% of fistulae were never used for haemodialysis. Hence it is no longer justifiable to create backup fistulae in CAPD patients.
为持续非卧床腹膜透析（CAPD）患者建立备用动静脉内瘘的理由是，许多患者将需要紧急血液透析，随后还需要长期血液透析。英国42%的肾脏科室有一项政策，即向CAPD患者提供备用动静脉内瘘。我们研究了这一政策是否合理。在我们科室，1986年至1989年间开始接受CAPD治疗的176例患者中，大多数（73%）在中位随访期4年内不需要血液透析。在114例患者中建立的153个备用内瘘中，只有10个曾用于紧急血液透析。另外23例患者需要紧急血液透析，但在需要时他们的内瘘已不再发挥作用。本研究中患者的内瘘平均通畅时间与其他已发表研究中的情况相比非常有利。这一发现表明，大多数内瘘在需要时无法用于紧急血液透析。94%的内瘘从未用于血液透析。因此，为CAPD患者建立备用内瘘不再合理。
