만성신부전 환자에서 첫 혈액투석 시작 시 동정맥루 대신 카테터를 사용한 원인 분석 = The Reasons for Use of Temporary Catheter Instead of Arteriovenous Fistula at the Start of Chronic Hemodialysis Therapy

다국어 초록 (Multilingual Abstract)

Purpose:Placement of an arteriovenous fistula (AVF) before initiation of chronic hemodialysis (HD) is recommended to avoid the use of a dialysis catheter. However, many patients use temporary catheter at the start of HD for many reasons. We conducted a study to examine the reasons for use of temporary catheter instead of AVF at initial HD therapy.
Methods:We investigated 61 chronic renal failure (CRF) patients who started HD from January 2001 to August 2004 at Daegu Fatima Hospital. Fourty one of them used temporary catheter (catheter group) and 20 used AVF (AVF group) at initial HD. The causes of CRF, clinical presentation at initial HD, reasons that required start of HD and reasons for use of temporary catheter were investigated.
Results:The reasons that required start of HD were dyspnea (23), uremic symptoms (11), severe edema (4) and metabolic abnormalities (3) in catheter group and uremic symptoms (8), progression of CRF with minimal uremic symptoms (8) in AVF group. Those causes of unpreparedness of AVF in catheter group were delayed referral (12), rapid progression of CRF (12), unawareness of CRF (10), and noncompliance (7). The systolic and diastolic blood pressure were higher in catheter group than AVF group (171.3±33.5 vs 146.0±18.0 mmHg, 94.0±18.5 vs 80.6±10.8 mmHg, respectively). Serum albumin level was lower (3.0±0.6 vs 3.4±0.7 g/dL) and serum phosphorus level was higher (6.8±1.9 vs 5.7±1.7 mg/dL) in catheter group.
Conclusion:To avoid temporary vascular catheter, early diagnosis of CRF, early referral to nephrologist and preparation of AVF is essential.

국문 초록 (Abstract)

목 적:동정맥루는 혈액투석을 시작하기 위해 필수적이나 여러 원인으로 카테터를 통한 응급 혈액투석으로 신대체요법을 시작하는 경우가 많다. 이 연구는 동정맥루를 확보하지 못하고 카테터를 통해 응급 혈액투석을 시작한 원인을 알아보고자 하였다.
방 법:2001년 1월부터 2004년 8월까지 대구 파티마병원에서 혈액투석을 처음 시작한 환자 61명을 대상으로 하였다. 카테터로 투석을 시작한 환자 (카테터군)는 41명이었고 동정맥루로 투석을 시작한 환자 (동정맥루군)는 20명이었다. 두 군의 투석 시작 당시 임상 양상과 카테터군에서 응급 혈액투석이 필요했던 원인과 동정맥루를 준비하지 못한 원인을 분석하였다.
결 과:카테터 군에서 응급 혈액투석이 필요했던 증상은 호흡곤란 (23예) 요독증 (11예), 심한 부종 (4예), 대사 이상 (3예)이었다. 동정맥루를 준비 못한 원인은 지연 의뢰 12명 (투석 시작 전 <6개월), 만성신부전의 급성 악화 12명, 투석 시작 당시 처음 신부전 진단 10명, 투석 권유 불응 7명이었다. 카테터군에서 동정맥루군보다 수축기 (171.3±33.5 vs 146.0±18.0 mmHg) 및 이완기 혈압 (94.0±18.5 vs 80.6±10.8 mmHg)이 각각 높았고, 혈청 알부민 농도는 낮았으며 (3.0±0.6 vs 3.4±0.7 g/dL), 인 농도는 높았다 (6.8±1.9 vs 5.7±1.7 mg/dL).
결 론:카테터 삽입을 통한 응급 투석 시작을 피하기 위해서는 신부전 환자의 조기 발견 및 조기 의뢰와 투석 전 적절한 치료 및 동정맥루 확보가 필요할 것으로 생각된다.

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