背景:进行血液透析(HD)的静脉通路使患者更容易发生短暂性菌血症,易患感染性心内膜炎(IE)的发展。在该人群中观察到的风险因素包括暂时获得HD,低蛋白血症,糖尿病,女性性别,贫血,和耐甲氧西林金黄色葡萄球菌(MRSA)定植。
方法:2010年至2020年,在ComplejoHospitalarioArnulfoAriasMadrid博士(CHDrAAM)对接受肾脏替代治疗的慢性肾病(CKD)患者进行了1比2的回顾性病例对照研究。社会人口统计学变量,既往病史,并研究了当前HD的数据。计算收集的变量的比值比(OR)和调整后的比值比(aOR)。
结果:两组之间在社会人口统计学变量方面没有观察到统计学上的显着差异。就过去的病史而言,这些病例以冠状动脉疾病为主(47.6%vs4.8%;OR:37.27),瓣膜疾病(23.8%vs0%),心力衰竭(33.3%vs4.8%;OR:10)。在案件中,临时导管的使用更为普遍(61.9%vs33.3%;OR:3.25),并且锁骨下动脉入路记录更频繁(28.6%vs2.4%;OR:14.4).在更大比例的病例中发现了较短的静脉通路持续时间(<30天)(23.8%vs4.8%;OR:6.25)。主要病原菌为金黄色葡萄球菌(33.3%),受影响最大的瓣膜是主动脉瓣(59.1%)。100%的报告病例出现发热,高达47.6%的人最近出现杂音。
结论:与以前在其他国家进行的研究类似,我们确定了先前存在的瓣膜疾病史,使用临时导管,和最近的静脉通路是危险因素。与文献中报道的相反,这项研究没有发现女性,糖尿病,和低蛋白血症是风险。
结论:冠心病病史等因素,心力衰竭,先前存在的瓣膜疾病,使用临时导管,锁骨下静脉通路,静脉通路持续时间短(<30天)被确定为HDCKD患者发生IE的危险因素。
BACKGROUND: Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA).
METHODS: A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables.
RESULTS: No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur.
CONCLUSIONS: Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks.
CONCLUSIONS: Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.