vascular access for hemo dialysis

BACKGROUND: Treatment options for dialysis access steal syndrome (DASS) include distal revascularization with interval ligation (DRIL), proximalization of arterial inflow (PAI), access banding, and access ligation. This study examines the efficacy of DRIL in treating DASS and reports short-term bypass patency, access patency, and wound infection rates. METHODS: A retrospective analysis was performed on adults diagnosed with DASS following hemo-dialysis access creation who underwent DRIL procedures between January 1, 2009 and May 11, 2017...

Cardiovascular diseases are accountable for almost 50% of over-all mortality rates in chronic kidney disease (CKD) patients, especially in those who undergo hemo-dialysis or peritoneal dialysis.Hemodialysis patients present higher rates of pulmonary hypertension (PH), an independent risk factor for cardiovascular mortality among this patient population, due in part to the presence and hemodynamic effects of vascular access (both artero-venous fistula and central venous catheter). Echocardiographic TAPSE (tricuspid annular plane systolic excursion) index represents a helpful tool for investigation of right ventricular function together with PAPs (systolic pulmonary artery pressure) evaluation...

The mean age of the ESRD population continues to increase, with the 2011 USRDS Annual Data report noting it to be 62.6 years among a prevalent chronic dialysis population (both hemo- and peritoneal dialyses) of approximately 399,000. As with previous reports, the greatest growth rate per million population in the ESRD cohort occurs in age range >75 years. Entering the ESRD pool >75 years of age are about 5,000 patients/million population; in contrast, the number is about 2,100/million population that falls in the age range 45-65 years...

Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up...

BACKGROUND AND OBJECTIVES: In the Hemodialysis (HEMO) Study, observed small decreases in achieved equilibrated Kt/V(urea) were noncausally associated with markedly increased mortality. Here we examine the association of mortality with modeled volume (V(m)), the denominator of equilibrated Kt/V(urea). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Parameters derived from modeled urea kinetics (including V(m)) and blood pressure (BP) were obtained monthly in 1846 patients...

On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD) is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient's plasma conductivity can be calculated easily from on-line measurements at two different steps of dialysate conductivity...

Vascular access malfunctions can be diagnosed by means of imaging and non-imaging methods. The former are: ultrasound (US), colour Doppler ultrasonography, arteriography and phlebography. Radiological imaging allows for direct assessment of the morphology and function of the hemodialysis fistula, and shows precisely the kind and location of lesions, that may lead to access failure. The aim of the study was to present the algorithm of methods employed in evaluation of hemodialysis fistulae, that had been developed by the authors...

From 1.07.1994 to 30.06.2001 in the 2-nd Department of Surgery and Department of Nephrology Collegium Medicum Jagiellonian University, in 274 patients with terminal renal failure 341 vascular access for hemo-dialysis have been performed. Acute insufficiency in functioning arteriovenous fistulas occurred in 93 patients. In six of them, an attempt of thrombectomy was done. In 56 patients (group I) we carried out the new fistula on the same vascular level. In the remaining 31 cases (group II) we were forced to perform the procedure at a higher level...

Among the 1846 patients in the HEMO Study, chronic high-flux dialysis did not significantly affect the primary outcome of the all-cause mortality (ACM) rate or the main secondary composite outcomes, including the rates of first cardiac hospitalization or ACM, first infectious hospitalization or ACM, first 15% decrease in serum albumin levels or ACM, or all non-vascular access-related hospitalizations. The high-flux intervention, however, seemed to be associated with reduced risks of specific cardiac-related events...

Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection...

BACKGROUND: The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain. METHODS: We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer. RESULTS: In the standard-dose group, the mean (+/-SD) urea-reduction ratio was 66...

UNLABELLED: Presently, large venous vessel cannulation is the only procedure for attaining immediate dialysis access. As another option, vascular access may be a method for guaranteeing drug administration or parenteral feeding. The aim of the following paper was to evaluate the course of central venous catheter implantation and associated complications. The study included 235 patients (120 male, 115 female) between the ages of 24 and 87 years, treated at the Nephrology Department of the Jagiellonian University in Cracow from January, 1997 to March, 2001...

BACKGROUND: Arteriovenous (AV) fistulas are the vascular access of choice for hemodialysis patients, but only about 20% of hemodialysis patients in the United States dialyze with fistulas. There is little information known about the factors associated with this low prevalence of fistulas. METHODS: Multiple logistic regression analysis was used to evaluate the independent contribution of factors associated with AV fistula use among patients enrolled in the HEMO Study...

BACKGROUND: There is increasing interest in the use of continuous arteriovenous hemofiltration/dialysis for treatment of profound renal failure after cardiovascular operations. Vascular access for this is usually accomplished by percutaneous cannulation of the femoral artery and vein, with the inherent risks of vascular trauma, patient immobilization, hemorrhage, or infectious complications. METHODS: Fifteen (0.36%) of 4,166 patients receiving cardiovascular surgical procedures sustained postoperative renal failure requiring treatment with continuous arteriovenous hemofiltration/dialysis...

We report our experience with the subclavian vein as a route for temporary vascular access. By modifying the technique described by Uldall one can place these catheters at the bedside without the need of a separate exit tunnel. They are easily maintained in place and allow for early discharge home while awaiting permanent vascular access maturation. The results of approximately 600 dialysis treatments showed adequate clearence with a mean postdialysis drop in creatinine of 5.0mg./dl. and BUN of 46mg./dl. Complication rates were minimal with no hemo or pneumothorax...