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Dialysis vascular access

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https://www.readbyqxmd.com/read/29218694/training-vascular-access-surgeons-technicians-or-specialists
#1
Nicholas Inston, Tej M Singh
Internationally, vascular access (VA) surgery is delivered in a varied and diverse fashion and subsequently, training in vascular access is poorly defined. Experience of VA during surgical training has implications on future practice. The scope of VA procedures is increasing, yet the focus in vascular training remains largely in the technical aspects of surgery rather than the more comprehensive aspects of surgery applied to dialysis and renal care. To achieve special skills in vascular access surgery may require a change to traditional training with an additional focus on developing an extended portfolio of knowledge and skills...
December 4, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29212839/bp-in-dialysis-results-of-a-pilot-study
#2
Dana C Miskulin, Jennifer Gassman, Ronald Schrader, Ambreen Gul, Manisha Jhamb, David W Ploth, Lavinia Negrea, Raymond Y Kwong, Andrew S Levey, Ajay K Singh, Antonia Harford, Susan Paine, Cynthia Kendrick, Mahboob Rahman, Philip Zager
The optimal BP target for patients receiving hemodialysis is unknown. We randomized 126 hypertensive patients on hemodialysis to a standardized predialysis systolic BP of 110-140 mmHg (intensive arm) or 155-165 mmHg (standard arm). The primary objectives were to assess feasibility and safety and inform the design of a full-scale trial. A secondary objective was to assess changes in left ventricular mass. Median follow-up was 365 days. In the standard arm, the 2-week moving average systolic BP did not change significantly during the intervention period, but in the intensive arm, systolic BP decreased from 160 mmHg at baseline to 143 mmHg at 4...
December 6, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29210176/online-measurement-of-hemodialysis-adequacy-using-effective-ionic-dialysance-of-sodium-a-review-of-its-principles-applications-benefits-and-risks
#3
REVIEW
Shakil Aslam, Subodh J Saggi, Moro Salifu, Robert J Kossmann
Dialysis dose is an important determinant of clinical outcomes in patients with end stage renal disease on maintenance dialysis. In clinical practice dialysis dose is monitored at least monthly by urea clearance based on Urea Kinetic Modeling. Online clearance monitoring using effective ionic dialysance (EID) of sodium (Na+ ) is available on some hemodialysis machines. This paper reviews the background, methodology, additional applications, and potential risks associated with EID. Effective ionic dialysance provides a reliable, real-time, noninvasive, and inexpensive measurement of dialysis dose during an ongoing hemodialysis (HD) session to allow interventions and assess the impact of these changes on clearance...
December 6, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29210164/relative-risk-of-home-hemodialysis-attrition-in-patients-using-a-telehealth-platform
#4
Eric D Weinhandl, Allan J Collins
INTRODUCTION: Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. METHODS: We compared risks of all-cause attrition, dialysis cessation (i...
December 6, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29202728/non-tunneled-versus-tunneled-dialysis-catheters-for-acute-kidney-injury-requiring-renal-replacement-therapy-a-prospective-cohort-study
#5
Mallika L Mendu, Megan F May, Arnaud D Kaze, Dionne A Graham, Salena Cui, Margaret E Chen, Naomi Shin, Ayal A Aizer, Sushrut S Waikar
BACKGROUND: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high morbidity, mortality and resource utilization. The type of vascular access placed for AKI-RRT is an important decision, for which there is a lack of evidence-based guidelines. METHODS: We conducted a prospective cohort study over a 16-month period with 154 patients initiated on AKI-RRT via either a non-tunneled dialysis catheter (NTDC) or a tunneled dialysis catheter (TDC) at an academic hospital...
December 4, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29198387/international-differences-in-the-location-and-use-of-arteriovenous-accesses-created-for-hemodialysis-results-from-the-dialysis-outcomes-and-practice-patterns-study-dopps
#6
Ronald L Pisoni, Lindsay Zepel, Richard Fluck, Charmaine E Lok, Hideki Kawanishi, Gültekin Süleymanlar, Haimanot Wasse, Francesca Tentori, Jarcy Zee, Yun Li, Douglas Schaubel, Steven Burke, Bruce Robinson
BACKGROUND: Vascular access practice is strongly associated with clinical outcomes. There is substantial international variation in the use of arteriovenous fistulas (AVFs) and grafts (AVGs), as well as AVF maturation time and location. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Hemodialysis patients participating in the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) from the United States, Japan, and Europe/ANZ (Belgium, France, Germany, Italy, Spain, Sweden, United Kingdom, Australia, and New Zealand), including 3,850 patients receiving 4,247 new AVFs and 842 patients receiving 1,129 new AVGs in 2009 to 2015...
November 29, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29192721/haemodialysis-vascular-access-current-practices-amongst-indian-nephrologists
#7
Dinesh Bansal, Vijay Kher, Krishan Lal Gupta, Debasish Banerjee, Vivekanand Jha
INTRODUCTION: Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. METHODS: An online survey was emailed to 920 Indian nephrologists and 388 (42.1%) responded; 98.5% of whom were responsible for managing dialysis patients, 98% in hospitals. RESULTS: Sixty-four percent of patients initiated renal replacement therapy with HD, 7% with peritoneal dialysis, 10% kidney transplantation and 19% conservative care...
November 25, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29188361/disruptive-technological-advances-in-vascular-access-for-dialysis-an-overview
#8
REVIEW
Wee-Song Yeo, Qin Xiang Ng
End-stage kidney disease (ESKD), one of the most prevalent diseases in the world and with increasing incidence, is associated with significant morbidity and mortality. Current available modes of renal replacement therapy (RRT) include dialysis and renal transplantation. Though renal transplantation is the preferred and ideal mode of RRT, this modality may not be available to all patients with ESKD. Moreover, renal transplant recipients are constantly at risk of complications associated with immunosuppression and immunosuppressant use, and posttransplant lymphoproliferative disorder...
November 29, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29187653/-investigation-of-status-for-vascular-access-in-hemodialysis-patients-at-xiangya-hospital-of-central-south-university
#9
Yong Zhong, Jiaxi Pu, Xiang Ao, Weisheng Peng, Zhangzhe Peng, Xiaozhao Li, Xiangcheng Xiao, Qiaoling Zhou, Ping Xiao
To investigate the status of vascular access in hemodialysis patients in our center.
 Methods: The general information of hemodialysis patients and types and complications of vascular access at Xiangya Hospital of Central South University from April 2015 to April 2016, were retrospectively analyzed.
 Results: Among 258 prevalent patients, 87.60% of them had arteriovenous fistula (AVF), while 12.40% showed tunneled cuffed catheter. Of the 61 incident patients, 80.33% of them initiated dialysis with a non-tunneled and non-cuffed catheter, 8...
November 28, 2017: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/29186549/intradialytic-hypertension-is-associated-with-low-intradialytic-arterial-oxygen-saturation
#10
Anna Meyring-Wösten, Ya Luo, Hanjie Zhang, Priscila Preciado, Stephan Thijssen, Yuedong Wang, Peter Kotanko
Background: The pathophysiology of a paradoxical systolic blood pressure (SBP) rise during hemodialysis (HD) is not yet fully understood. Recent research indicated that 10% of chronic HD patients suffer from prolonged intradialytic hypoxemia. Since hypoxemia induces a sympathetic response we entertained the hypothesis that peridialytic SBP change is associated with arterial oxygen saturation (SaO 2 ). Methods: We retrospectively analyzed intradialytic SaO 2 and peridialytic SBP change in chronic HD patients with arteriovenous vascular access...
November 24, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29162677/feasibility-of-urgent-start-peritoneal-dialysis-in-older-patients-with-end-stage-renal-disease-a-single-center-experience
#11
Haijiao Jin, Zhaohui Ni, Shan Mou, Renhua Lu, Wei Fang, Jiaying Huang, Chunhua Hu, Haifen Zhang, Hao Yan, Zhenyuan Li, Zanzhe Yu
BACKGROUND: Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. METHODS: This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014...
November 21, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/29148001/an-arterioarterial-prosthetic-graft-as-an-alternative-option-for-haemodialysis-access-a-systematic-review
#12
Matthew J Grima, Bianca Vriens, Peter J Holt, Eric Chemla
INTRODUCTION: All arteriovenous fistula/grafts options should be exhausted before haemodialysis is carried out via central venous catheters (CVC). CVCs carry high morbidity and mortality risks and in some patients, the central veins could be exhausted. In these patients, an arterioarterial prosthetic loop (AAPL) or straight graft can be the only option for haemodialysis. A systematic review was thus carried out to look at the use of arterioarterial graft for haemodialysis, with regards to dialysis adequacy, complications, and patency rates...
November 10, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29130991/pre-end-stage-renal-disease-hemoglobin-variability-predicts-post-end-stage-renal-disease-mortality-in-patients-transitioning-to-dialysis
#13
Keiichi Sumida, Charles Dyer Diskin, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Connie M Rhee, Elani Streja, Kunihiro Yamagata, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Hemoglobin variability (Hb-var) has been associated with increased mortality both in non-dialysis dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD) patients. However, the impact of Hb-var in advanced NDD-CKD on outcomes after dialysis initiation remains unknown. METHODS: Among 11,872 US veterans with advanced NDD-CKD transitioning to dialysis between October 2007 through September 2011, we assessed Hb-var calculated from the residual SD of at least 3 Hb values during the last 6 months before dialysis initiation (prelude period) using within-subject linear regression models, and stratified into quartiles...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/29122210/strategies-to-increase-patient-safety-in-hemodialysis-application-of-the-modal-analysis-system-of-errors-and-effects-fema-system
#14
María Dolores Arenas Jiménez, Gabriel Ferre, Fernando Álvarez-Ude
BACKGROUND: Haemodialysis (HD) patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, systems that ensure the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement. OBJECTIVES: To show a systematic working approach, reproducible in any HD unit, which consists of recording the complications and errors that occurred during the HD session; defining which of those complications could be considered adverse event (AE), and therefore preventable; and carrying out a systematic analysis of them, as well as of underlying real or potential errors, evaluating their severity, frequency and detection; as well as establishing priorities for action (Failure Mode and Effects Analysis system [FMEA systems])...
November 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/29106711/interventions-for-treating-central-venous-haemodialysis-catheter-malfunction
#15
REVIEW
Alice L Kennard, Giles D Walters, Simon H Jiang, Girish S Talaulikar
BACKGROUND: Adequate haemodialysis (HD) in people with end-stage kidney disease (ESKD) is reliant upon establishment of vascular access, which may consist of arteriovenous fistula, arteriovenous graft, or central venous catheters (CVC). Although discouraged due to high rates of infectious and thrombotic complications as well as technical issues that limit their life span, CVC have the significant advantage of being immediately usable and are the only means of vascular access in a significant number of patients...
October 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29103931/timely-thrombectomy-can-improve-patency-of-hemodialysis-arteriovenous-fistulas
#16
Mu-Yang Hsieh, Lin Lin, Tsung-Yan Chen, Dao-Ming Chen, Ming-Hsien Lee, Yung-Fang Shen, Chung-Wei Yang, Shao-Yuan Chuang, Chih-Cheng Wu, Kuan-Yu Hung
OBJECTIVE: The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis. METHODS: A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution...
November 2, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29080304/high-resolution-computational-fluid-dynamic-simulation-of-haemodialysis-cannulation-in-a-patient-specific-arteriovenous-fistula
#17
David Fulker, Bogdan Ene-Iordache, Tracie J Barber
Arteriovenous fistulae are the preferred choice of vascular access in hemodialysis patients, however complications such as stenosis can lead to access failure or recirculation, which reduces dialysis efficiency. This study utilized computational fluid dynamics on a patient specific radio-cephalic fistula under hemodialysis treatment to determine the dynamics of access recirculation and identify the presence of disturbed flow. Metrics of transverse wall shear stress and oscillatory shear index were used to characterize the disturbed flow acting on the blood vessel wall, whilst a power spectral density analysis was used to calculate the any turbulence within the access...
October 28, 2017: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/29076517/association-between-post-dialysis-hemoglobin-level-and-the-survival-of-vascular-access
#18
Hiroki Nishiwaki, Takeshi Hasegawa, Tatsuyoshi Ikenoue, Naoto Tominaga, Masahiko Yazawa, Hiroo Kawarazaki, Yugo Shibagaki, Yosuke Yamamoto, Shingo Fukuma, Shin Yamazaki, Shunichi Fukuhara
INTRODUCTION: Although a few dialysis facilities conduct a complete blood cell count for some patients at post-dialysis, including hemoglobin, clinical findings supporting the interpretation of results are scarce. The aim of this study was to investigate the association between post-dialysis hemoglobin level and vascular access failure with clinical data. METHODS: Study design: Case crossover design. Setting: Japanese dialysis facilities, which routinely take post-dialysis blood samples, including complete blood cell counts at least once a month...
October 24, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29045916/suicide-deaths-among-patients-with-end-stage-renal-disease-receiving-dialysis-a-population-based-retrospective-cohort-study-of-64-000-patients-in-taiwan
#19
I-Ming Chen, Po-Hsien Lin, Vin-Cent Wu, Chi-Shin Wu, Jia-Chi Shan, Shu-Sen Chang, Shih-Cheng Liao
BACKGROUND: Patients with end-stage renal disease (ESRD) who receive dialysis may experience increased distress and risk of suicide. METHODS: This population-based retrospective cohort study linked Taiwan's national register of ESRD patients on dialysis and the cause-of-death mortality data file. A separate multiple-cause-of-death data file was used to investigate the detailed suicide methods used. Standardized mortality ratios (SMRs) were calculated for the overall patient group and by sex, age, year of initiating dialysis, method of suicide, and time since initiation of dialysis...
October 9, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/29044335/brazilian-chronic-dialysis-survey-2016
#20
Ricardo Cintra Sesso, Antonio Alberto Lopes, Fernando Saldanha Thomé, Jocemir Ronaldo Lugon, Carmen Tzanno Martins
INTRODUCTION: National chronic dialysis data are important for the treatment planning. OBJECTIVE: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2016. METHODS: A survey based on data of dialysis centers from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis centers. RESULTS: 309 (41%) of the dialysis units in the country answered the questionnaire...
July 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
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