Hakim R, Himmelfarb J
Vanderbilt University Medical Center, Department of Medicine, Nashville, Tennessee, USA.
Kidney Int. 1998 Oct;54(4):1029-40. doi: 10.1046/j.1523-1755.1998.00122.x.
Recent evidence suggests that the cost as well as the morbidity associated with the maintenance of hemodialysis access is increasing rapidly; currently, the cost exceeds 1 billion dollars and access related hospitalization accounts for 25% of all hospital admissions in the U.S.A. This increase in cost and morbidity has been associated with several epidemiological trends that may contribute to access failure. These include late patient referral to nephrologists and surgeons, late planning of vascular access as well as a shift from A-V fistulaes to PTFE grafts and temporary catheters, which have a higher failure rate. The reasons for this shift in the types of access is multifactorial and is not explained by changes in the co-morbidities of patients presenting to dialysis. Surgical preference and training also appear to play an important role in the large regional variation and patency rate of these PTFE grafts. We propose a program for early placement of A-V fistulae, a continuous quality improvement, multidisciplinary program to monitor access outcome, the development of new biomaterials, and a research plan to investigate pharmacological intervention to reduce development of stenosis and clinical interventions to treat those that do develop, prior to thrombosis.
最近的证据表明，维持血液透析通路的成本以及与之相关的发病率正在迅速上升；目前，成本超过10亿美元，与通路相关的住院治疗占美国所有住院病例的25%。成本和发病率的这种上升与几种流行病学趋势有关，这些趋势可能导致通路失败。这些趋势包括患者向肾病学家和外科医生的转诊延迟、血管通路规划延迟，以及从动静脉内瘘向聚四氟乙烯移植物和临时导管的转变，而后者的失败率更高。通路类型转变的原因是多方面的，并非由接受透析患者的合并症变化所解释。手术偏好和培训似乎在这些聚四氟乙烯移植物的巨大区域差异和通畅率中也起着重要作用。我们提出了一个项目，包括早期放置动静脉内瘘、持续质量改进、监测通路结果的多学科项目、开发新的生物材料，以及一项研究计划，旨在研究药物干预以减少狭窄的发生，并在血栓形成之前对已发生狭窄的情况进行临床干预治疗。
