目的:这项横断面调查旨在确定亚太地区(APR)肾脏病学家中介入肾脏病学(IN)的患病率,具体涉及透析接入(DA)。
方法:来自印度的VA和干预协会TionAl肾脏医师(AVATAR)基金会在亚太地区的肾脏病学家中进行了一项跨国在线调查,以确定计划中的IN做法,创作,和透析通道的管理。治疗方式,人力和设备可用性,每月的治疗费用,透析接入干预措施的细节,调查中包括了肾脏病学家在培训和实践中遇到的挑战。
结果:来自APR的21个国家参加了调查。来自18个(85.7%)国家的肾脏科医师报告说,至少执行了一项与透析接入相关的基本IN程序。主要是放置非隧道式中央导管(n-TCC;71.5%)。只有10个国家(47.6%)报告说,平均<4%的肾脏病学家执行任何先进的IN接入程序,最常见的是放置腹膜透析(PD)导管(20%)。缺乏正规培训(57.14%),时间(42.8%),奖励(38%),机构支持(38%),医疗法律保护(28.6%),高昂的成本(23.8%)是实施IN的主要挑战。实施城市信息化培训的主要障碍是缺乏资金和技术人员。
结论:在APR中与透析相关的IN的实践不足,主要是因为缺乏训练,备份支持,和经济限制,而与接入相关的IN培训受到缺乏熟练劳动力和资金的限制。
OBJECTIVE: This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA).
METHODS: The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey.
RESULTS: Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel.
CONCLUSIONS: The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.