Kidney Research and Clinical Practice

Korean Society of Nephrology (대한신장학회)
권호 표지

Vascular Access Monitoring and Surveillance in Hemodialysis Patients

혈액투석 환자에서 혈관통로 기능이상에 대한 추적관리

Kim, Young-Ok
김영옥

  • Published : 20081100
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Abstract

1. 향후 혈액투석을 받을 예정인 만성신부전증 환자는 가급적 CKD stage 4단계 (사구체여과율 30 mL/min/1.73m2) 에서부터 신장내과 전문의에게 조기 의뢰하여 혈관관리를 시작해야 한다. 수술부위에서 동맥 및 정맥 주사기 천자를 피하고 등척성 팔운동을 교육하여 혈관 발달을 유도해야 한다. 2. 가급적 도관 사용을 최소화 하기 위해 수술 시기를 동정맥루는 첫 투석이 예상되는 시점에서 6개월, 동정맥이식편은 3-6주 이전으로 정하는 것을 원칙으로 하나 혈관상태가 양호한 환자에서는 다소 늦게 시행할 수 있다. 3. 동정맥루 첫 주사기 천자는 가급적 rule of 6에 부합하는지를 확인한 후에 시행하는 것이 좋으나 도플러 초음파 검사가 어려운 경우에는 정기적인 시진, 청진, 촉진 등의 이학적 검사를 통하여 기능이상을 조기에 찾아내는 것이 중요하다. 4. 이학적 검사 외에 객관적이고 정확한 검사방법에는 정적인 정맥압 (SIAPR)과 도플러초음파 검사 혹은 초음파희석법을 이용한 혈류량 측정이 있다. 가급적 두 방법 중에 한가지 이상을 이용하는 것이 정확도를 높이는데 도움이 된다. 5. 동정맥루 기능이상이 의심되면 최종 검사로 정맥조영술을 시행하여 협착증이 발견되면 외과적 수술에 앞서 혈관확장술을 시행한다.

Keywords

References

  1. ESRD Registry Committee: Current Renal Replacement Therapy in Korea- Insan Memorial Dialysis Registry 2006-. Korean J Nephrol 26(Suppl2):S459-S481, 2007
  2. Fan PY, Schwab SJ: Vascular access : Concepts for the 1990s. J Am Soc Nephrol 3:1-11, 1992
  3. Beathard GA, Settle SM, Shields MW: Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 33:910-916, 1999 https://doi.org/10.1016/S0272-6386(99)70425-7
  4. Schwab SJ, Harrington JT, Singh A, Roher R, Shohaib SA, Perrone RD, Meyer K, Beasley D: Vascular access for hemodialysis. Kidney Int 55:2078-2090, 1999 https://doi.org/10.1046/j.1523-1755.1999.00409.x
  5. Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, Wolfe RA, Goodkin DA, Held PJ: Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 61:305-316, 2002 https://doi.org/10.1046/j.1523-1755.2002.00117.x
  6. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 48(Suppl 1):S176-S247, 2006 https://doi.org/10.1053/j.ajkd.2006.04.029
  7. Asif A, Cherla G, Merrill D, Cipleu CD, Tawakol JB, Epstein DL, Lenz O: Venous mapping using venography and the risk of radiocontrast-induced nephropathy. Semin Dial 18:239-242, 2005 https://doi.org/10.1111/j.1525-139X.2005.18319.x
  8. Leaf DA, MacRae HS, Grant E, Kraut J: Isometric exercise increases the size of forearm veins in patients with chronic renal failure. Am J Med Sci 325:115-119, 2003 https://doi.org/10.1097/00000441-200303000-00003
  9. Park KY, Cho JW, Yeo MA, Yang HW, Kim KH, Lee KS, Koo JR, Kim GH, Chun RW, Kim HJ, Chae DW, Noh JW: The influence of maturation period of arteriovenous fistula on its survival in patients undergoing maintenance hemodialysis. Korean J Med 57:66-74, 1999
  10. Lenz O, Sadhu S, Fornoni A, Asif A. Overutilization of central venous catheters in incident hemodialysis patients: reasons and potential resolution strategies. Semin Dial 19:543-550, 2006 https://doi.org/10.1111/j.1525-139X.2006.00220.x
  11. Chesser AM, Baker LR. Temporary vascular access for first dialysis is common, undesirable and usually avoidable. Clin Nephrol 51:228-232, 1999
  12. Yoon HE, Chung S, Chung HW, Shin MJ, Lee SJ, Kim YS, Kim HW, Song HC, Yang CW, Jin DC, Kim YS, Kim SY, Choi EJ, Chang YS, Kim YO: Status of Initiating Pattern of Hemodialysis: A Multi-center Study. J Korean Med Sci (in press)
  13. Choi JR, Kim YS, Yoon SA, Won YD, Son YS, Son YS, Song WJ, Song HC, Kim YS, Chang YS, Bang BK, Kim YO: Accuracy of physical examination in detecting arteriovenous fistula dysfunction in hemodialysis patients : comparison with venographic findings. Korean J Nephrol 25:797-802, 2006
  14. Leon C, Orozco-Vargas LC, Krishnamurthy G, Choi KL, Mercado C, Merrill D, Thomas I, Salman L, Artikov S, Bourgoignie JJ, Asif A: Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial 21:85-88, 2008 https://doi.org/10.1111/j.1525-139X.2007.00382.x
  15. Kim YO, Song HC, Yoon SA, Yang CW, Kim NI, Choi YJ, Lee EJ, Kim WY, Chang YS, Bang BK: Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients. Am J Kidney Dis 41:422-428, 2003 https://doi.org/10.1053/ajkd.2003.50051
  16. Kim YO, Choi YJ, Kim JI, Kim YS, Kim BS, Park CW, Song HC, Yoon SA, Chang YS, Bang BK: The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. J Korean Med Sci 21:284-289, 2006 https://doi.org/10.3346/jkms.2006.21.2.284
  17. Ku YM, Kim YO, Kim JI, Oh SS, Kim YS, Yoon SA, Won WD, Kim KT, Chang YS, Bang BK: Clinical significance of routine fistulography at postoperative 1 month in patients receiving native arteriovenous fistula. Korean J Nephrol 24:951-956, 2005
  18. Besarab A, Al-Saghir F, Alnabhan N, Lubkowski T: Simplified measurement of intra-access pressure. ASAIO J 42:M682-M687, 1996 https://doi.org/10.1097/00002480-199609000-00074
  19. Besarab A, Sullivan KL, Moritz M: The utility of intra-access pressure monitoring in detecting and correcting vascular access stenosis. Semin Dial 8:137-141, 1995 https://doi.org/10.1111/j.1525-139X.1995.tb00361.x
  20. Lee JP, Kim YO, Song WJ, Song HC, Kim YS, Yoon SA, Kim YS, Kim SY, Choi EJ, Chang YS, Bang BK: The comparison of Access Alert and drip chamber methods in measuring static venous pressure in hemodialysis patients. Korean J Nephrol 25:283-288, 2006
  21. Jung HW, Kim YO, Song WJ, Kim YS, Yoon SA, Kim BS, Song HC, Kim SY, Choi EJ, Chang YS, Bang BK: Static venous pressure measurement by Access Alert in detecting vascular access stenosis. Korean J Nephrol 25:61-68, 2006
  22. Kim YO, Yang CW, Yoon SA, Chun KA, Kim NI, Park JS, Kim BS, Kim YS, Chang YS, Bang BK: Access blood flow as a predictor of early failures of native arteriovenous fistulas in hemodialysis patients. Am J Nephrol 21:221-225, 2001 https://doi.org/10.1159/000046251
  23. Lee KH, Park JY, Choi SJ, Kim JK, Hwang SD, Joh JH: Clinical utility of access blood flow measurement by ultrasound dilution in hemodialysis patients. Korean J Nephrol 24:265-273, 2005
  24. Song HH, Won YD, Kim YO, Yoon SA: Salvaging and maintaining non-maturing Brescia-Cimino haemodialysis fistulae by percutaneous intervention. Clin Radiol 61:404-409, 2006 https://doi.org/10.1016/j.crad.2005.12.012
  25. Yoon JM, Song HH, Kim YO, Kim YS, Chang YK, Kim HW, Song HC, Yoon SA, Kim SY, Choi EJ, Chang YS, Bang BK: Central venous stenosis in chronic hemodialysis patients: the effect of percutaneous angioplasty and stenting. Korean J Nephrol 23:763-768, 2004
  26. Kim YO, Yoon SA, Kim YS, Kim MK, Oh HJ, Ku YM, Song HH, Kim KT, Chang YS, Bang BK: Early dysfunction of radiocephalic arteriovenous fistula: primary and secondary patency rate of percutaneous angioplasty. Korean J Nephrol 22:414-419, 2003