Modelo de manejo multidisciplinar de catéteres permanentes tunelizados: resultados de 5 años

Abstract

Patients in a hemodialysis (HD) programme is one of the most important challenges facing Nephrology. The ideal vascular (VA) access is one that provides adequate flow for dialysis, has a long half-life and low complication rate. Autologous arteriovenous fistula (AVF) best meets these conditions, has the lowest rate of infection and thrombosis and is recommended as the first choice whenever possible. KDOQUI in 2000, and its update in 2006, recommend the use of FAVI as a first choice, considering that it should be the AV in at least 50% of incident patients in HD, and 65% in prevalent ones. Similarly, they advise against the use of a Tunneled Indwelling Catheter (TOC), recommending a percentage of less than 10% of incident patients and limiting its use to specific cases. The SEN guidelines (advanced chronic renal disease and predialysis 2008; vascular access 2004) coincide: FAVi is the first option, when this is not possible, PTFE prosthetic AV will be used and the central venous catheter (CVC) is the last choice after the two previous ones. Numerous publications in recent years alert us to the consequences in terms of morbimortality and economic cost according to the vascular access used in each patient. Thus, LVAF is associated with greater patient survival and lower cost, while at the other extreme there are many studies that warn of the deleterious effects of the use of CVCs on patient prognosis. In Spain, the MAR study, a multi-centre study that included more than 1,700 patients, and the study of the Andalusian patient registry (2,400 patients in a four-year period) concluded that "Mortality in patients with CPT or PTFE prostheses is significantly higher than in patients with FAVI", with a survival rate of 73.7% for patients with FAVI and 49% for those with CVC". This effect of the catheters is independent of the patient's initial comorbidity.