Pulmonary arterial hypertension is one of the clinical groups of arterial hypertension. It is a rare, chronic disease with a very poor prognosis. Diagnostic procedures ruling out different causes of present symptoms and other forms of pulmonary hypertension are difficult and specific. Current European guidelines recommend combined treatment with endothelin receptor antagonist, prostanoids, and phosphodiesterase type 5 inhibitors.
Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.
Introduction: Progression of renal failure leads to an increase in the number of patients who require forming dialysis access. Old age and rising morbidity make it impossible to form a native arteriovenous fistula and a permanent catheter becomes the first choice. The presence of a catheter frequently generates complications, including infections, which may result in a higher mortality rate. Material and methods: A retrospective analysis data has been conducted, involving 398 patients who had permanent catheters implanted from 2010 to 2016. Out of this group, 65 patients who suffered infectionrelated complications have been identified. Risk factors for infection and a survival rate of the population have been estimated. Results: Between 2010 and 2016, 495 catheters were implanted for 398 patients aged 68.73 (13.26) years on average. 92 catheter-related infections (23.1%) were recorded in 65 patients. Multivariate logistic regression showed, that the risk factors of infectious complications were: younger age (P = 0.000), coronary artery disease (P = 0.006) and heart failure (P = 0.000). Mortality in the mean 1.38 ± 1.17 years followup period was comparable in infectious and non-infectious subgroups (53.85% vs 49.25%; P = 0.588). A higher risk of death in the infectious population was associated with the presence of additional intravascular and intracardiac implanted materials (P = 0.027) and a severe course of infection with hypotension (P = 0.027), thrombocytopenia (P = 0.029) and a high leucocytes/platelets ratio (0.017). Conclusion: Infectious complications in patients dialyzed with permanent catheters are dangerous especially in patients with severe clinical course. The mortality rate is high, although similar to all dialyzed by permanent catheters.
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