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hemodialysis vascular access

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https://www.readbyqxmd.com/read/29784614/tradeoffs-in-vascular-access-selection-in-elderly-patients-initiating-hemodialysis-with-a-catheter
#1
Timmy Lee, Joyce Qian, Mae Thamer, Michael Allon
RATIONALE & OBJECTIVE: National vascular access guidelines recommend placement of arteriovenous fistulas (AVFs) over grafts (AVGs) in hemodialysis patients, but have not been comprehensively assessed in the elderly. We evaluated clinically relevant vascular access outcomes in elderly patients receiving an AVF or AVG after hemodialysis therapy initiation. STUDY DESIGN: Retrospective cohort study using national administrative data. SETTINGS & PARTCIPANTS: Claims data from the US Renal Data System of 9,458 US patients 67 years and older who initiated hemodialysis therapy from July 1, 2010, to June 30, 2011, with a catheter and received an AVF (n=7,433) or AVG (n=2,025) within the ensuing 6 months...
May 18, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29750827/self-cannulation-of-the-vascular-access-in-home-hemodialysis-overcoming-patient-level-barriers
#2
Frank L Ward, Rose Faratro, Rory F McQuillan
Patients with end-stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self-cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self-cannulating patients have superior outcomes. Patient-level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients. The healthcare team must address patient fears while instructing the patient to perform self-cannulation safely...
May 11, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29742952/a-pilot-study-to-measure-vascular-compliance-changes-during-fistula-maturation-using-open-source-software
#3
Barry Belmont, Dae Woo Park, Albert Shih, Matthew Leavitt, Brett Plattner, Peter K Henke, William F Weitzel
PURPOSE: Autogenous arteriovenous fistulas are the preferred access for hemodialysis. Yet when created, fistulas often fail to mature, requiring surgical or radiologic interventions before their use. This pilot study measures the vascular wall elasticity and flow gradient using an open-source ultrasound software program designed to aid in assessing fistula maturation. METHODS: A total of seven end-stage renal disease patients were enrolled for our study after providing informed consent...
May 1, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29730781/role-of-antiplatelet-therapy-in-the-durability-of-hemodialysis-access
#4
Satinderjit Locham, Robert J Beaulieu, Hanaa Dakour-Aridi, Besma Nejim, Mahmoud B Malas
BACKGROUND: Antiplatelet therapy (APT) is often used on anecdotal grounds to improve vascular access patency. The aim of this study was to assess the role of APT in hemodialysis (HD) patients undergoing arteriovenous fistula (AVF) or graft (AVG) placement. METHODS: All patients in a large HD vascular qualitative initiative database (2011-2017) were included and divided into no antiplatelet therapy (no-APT) vs. any APT [aspirin (ASA) or P2Y12 inhibitors (PI)]. Multivariate [logistic (MLR) and Cox (MCR) regression] analyses were used as appropriate...
May 5, 2018: Journal of Nephrology
https://www.readbyqxmd.com/read/29724122/a-meta-analysis-of-the-association-between-diabetic-patients-and-avf-failure-in-dialysis
#5
Yan Yan, Dan Ye, Liu Yang, Wen Ye, Dandan Zhan, Li Zhang, Jun Xiao, Yan Zeng, Qinkai Chen
PURPOSE: The most preferable vascular access for patients with end-stage renal failure needing hemodialysis is native arteriovenous fistula (AVF) on account of its access longevity, patient morbidity, hospitalization costs, lower risks of infection and fewer incidence of thrombotic complications. Meanwhile, according to National Kidney Foundation (NKF)̸Dialysis Out-comes Quality Initiative (DOQI) guidelines, AVF is more used than before. However, a significant percentage of AVF fails to support dialysis therapy due to lack of adequate maturity...
November 2018: Renal Failure
https://www.readbyqxmd.com/read/29703700/improved-patency-of-eptfe-grafts-as-a-hemodialysis-access-site-by-seeding-autologous-endothelial-cells-expressing-fibulin-5-and-vegf
#6
Itai Tzchori, Mizied Falah, Denis Shteynberg, Dana Levin Ashkenazi, Zeev Loberman, Luba Perry, Moshe Y Flugelman
Small caliber synthetic vascular grafts used for dialysis access sites have high failure rates due to neointima formation and thrombosis. Seeding synthetic grafts with endothelial cells (ECs) provides a biocompatible surface that may prevent graft failure. We tested the use of ePTFE grafts seeded with autologous ECs expressing fibulin-5 and vascular endothelial growth factor (VEGF), as a dialysis access site in a porcine model. We connected the carotid arteries and jugular veins of 12 miniature pigs using 7-mm ePTFE grafts; five grafts were seeded with autologous venous ECs modified to express fibulin-5 and VEGF, and seven unseeded grafts were implanted at the same location and served as controls...
April 5, 2018: Molecular Therapy: the Journal of the American Society of Gene Therapy
https://www.readbyqxmd.com/read/29703177/functional-status-pre-dialysis-health-and-clinical-outcomes-among-elderly-dialysis-patients
#7
Silvi Shah, Anthony C Leonard, Charuhas V Thakar
BACKGROUND: Elderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied. METHODS: We studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation...
April 27, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29701407/creative-vascular-access-construction-in-same-patient
#8
Pedro Pinto Sousa, Paulo Almeida, Pedro Sá Pinto, Rui Almeida
INTRODUCTION: Creating and maintaining a functional vascular access(VA) is a critical factor in the survival of a dialysis patient. However, it will not function forever, implying a creative attitude from the vascular surgeon either to maintain its functionality or built a new one wherever possible, being it autologous or synthetic. METHODS: Describe the VA history of a 59years-old male with morbid obesity and end-stage chronic kidney disease. RESULTS: His VA construction started in2012 with failed attempts in both forearms until a functional brachiocephalic artery-venous fistula(AVF) in the right upper limb was achieved, but was deemed to ligation as severe venous hypertension secondary to central venous disease related to CVC use...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29697182/leadless-pacemaker-placement-in-a-patient-with-chronic-kidney-disease-a-strategy-to-preserve-central-veins
#9
Joan Alberto Maradey, Geoffrey Te Jao, Tushar J Vachharajani
Cardiac rhythm disorder is frequently encountered in hemodialysis patients and is often treated with a cardiovascular implantable electronic device (CIED). The conventional CIED requires placement of transvenous leads resulting in subclinical central venous stenosis, which can adversely affect the successful creation of a permanent dialysis vascular access. The technological advancement of a leadless pacemaker provides an opportunity to implement a strategy to preserve central veins in patients with chronic kidney disease...
April 26, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29680929/evaluation-of-factors-affecting-time-to-achieve-dry-weight-among-hemodialysis-patients-using-bioimpedance-spectroscopy
#10
Amjad Khan, Amer Hayat Khan, Azreen Syazril Adnan, Syed Azhar Syed Sulaiman, Nafees Ahmad, Siew Hua Gan
BACKGROUND: Achieving and maintaining dry weight appears to be an effective strategy for controlling and maintaining normotension among hypertensive patients on hemodialysis (HD). OBJECTIVE: The present study aimed to determine the time at which the majority of patients achieve postdialysis dry weight using bioimpedance spectroscopy (BIS). METHODS: A total of 220 HD patients were prospectively assessed for fluid overload using the Fresenius body composition monitor (BCM)...
April 22, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29678651/post-general-anesthesia-ultrasound-guided-venous-mapping-increases-autogenous-access-placement-rates
#11
C Y Maximilian Png, Adam Korayem, David J Finlay
OBJECTIVE: This study investigates the impact of introducing a post-general anesthesia ultrasound mapping (PAUS) on the type of vascular access chosen for hemodialysis in patients without previous accesses. METHODS: 203 of 297 consecutive patients met inclusion criteria and were reviewed. Within-subjects analysis was performed on patients with both an outpatient ultrasound-guided vein mapping and a PAUS using sign tests and Wilcoxon signed ranked tests. Further, a between-subjects analysis added patients with only the outpatient vein mapping; demographic and comorbidity data were analyzed using t-tests and chi-squared tests...
April 17, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29662810/clinical-results-of-arteriovenous-fistulas-constructed-using-autologous-vessels-in-end-stage-renal-disease-patients-on-hemodialysis
#12
Ki Tae Kim, Jae Wook Ryu, Pil Won Seo, Kyoung Min Ryu
Background: For hemodialysis patients with end-stage renal disease (ESRD), it is important to construct an efficient vascular access with a superior patency rate. This study investigated the factors influencing the efficiency of arteriovenous fistulas (AVFs) constructed using an autologous vessel and evaluated the necessity of ultrasonography as a preoperative tool for AVF construction. Methods: A retrospective analysis was performed of 250 patients in whom an AVF was constructed using an autologous vessel due to ESRD at our institution from January 2009 to April 2016...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29662315/pitfalls-in-the-ankle-brachial-index-and-brachial-ankle-pulse-wave-velocity
#13
Dai Ato
Background: The ankle-brachial index (ABI) and pulse wave velocity (PWV) are indices of atherosclerosis and arterial stiffness. The Japan-made measuring devices of those indices have spread widely because of their convenience and the significance of the parameters. However, studies that comprehensively discuss the various pitfalls in using these indices are not available. Methods: This study presents several representative pitfalls in using the ABI and brachial-ankle PWV (baPWV) by showing the result sheets of the device, "the Vascular Profiler"...
2018: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29657207/adoption-of-transposed-basilic-vein-as-access-for-hemodialysis
#14
Jacob A Akoh
The fistula first initiative has rekindled interest in transposition of basilic vein (TBV) in preference to arteriovenous grafts (AVG). TBV is considered to have advantages over AVG. The aim of this study was to analyze the outcome of TBVs in our center comparing them to a historically matched group of patients who had AVG. Thirty-two patients who underwent TBV as a vascular access procedure in Derriford Hospital between January 2010 and October 2014 were included in the study. The historical control group comprised 31 patients who had AVG inserted in the upper arm between January 1999 and December 2010...
March 2018: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/29656848/the-discipline-of-epidemiology-engaging-in-the-full-breadth-of-population-health-science
#15
Harold I Feldman
This address was delivered by Harold I. Feldman, MD, MSCE, at the Annual Meeting of the American College of Epidemiology in New Orleans, Louisiana, on September 26, 2017. Dr. Feldman is George S. Pepper Professor of Public Health and Preventive Medicine, Professor of Epidemiology and Medicine, and Chair, Department of Biostatistics, Epidemiology, and Informatics at the Perelman School of Medicine at the University of Pennsylvania. He is recognized nationally and internationally for his expertise in kidney disease epidemiology...
March 21, 2018: Annals of Epidemiology
https://www.readbyqxmd.com/read/29629274/current-characteristics-of-dialysis-therapy-in-korea-2016-registry-data-focusing-on-diabetic-patients
#16
Dong-Chan Jin, Sung-Ro Yun, Seoung Woo Lee, Sang-Woong Han, Won Kim, Jongha Park, Yong-Kyun Kim
Diabetic nephropathy is the most frequent cause of end-stage renal disease worldwide. Dialysis patients with diabetes mellitus (DM) have more complications and shorter survival duration than non-DM dialysis patients, requiring more clinical attention and difficult management. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an on-line registry program and analyzed the characteristics of patients. A survey of dialysis patients in 2016 showed that 50...
March 2018: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/29629273/korean-clinical-practice-guidelines-for-preventing-the-transmission-of-infections-in-hemodialysis-facilities
#17
Hayne Cho Park, Young-Ki Lee, Kyung Don Yoo, Hee Jung Jeon, Seung Jun Kim, Ajin Cho, Jacob Lee, Yang-Gyun Kim, Sang-Ho Lee, Sang-Oh Lee
Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities...
March 2018: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/29627998/physical-examination-of-the-hemodialysis-arteriovenous-fistula-to-detect-early-dysfunction
#18
Kenneth Abreo, Bakhtiar M Amin, Adrian P Abreo
The maintenance of vascular access patency for end-stage renal disease patients on hemodialysis is necessary for survival. Many nephrologists, nurse practitioners, and nurses have limited experience with the physical examination of the arteriovenous fistula. In this review, we define key terms used in the assessment of an arteriovenous fistula. We discuss the arteriovenous fistula physical exam, including details of inspection, palpation, and auscultation. Using these concepts, we review the abnormal findings that can assist practitioners in determining the location of a stenosis...
April 1, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29622355/a-prospective-randomized-study-of-stent-graft-placement-after-balloon-angioplasty-versus-balloon-angioplasty-alone-for-the-treatment-of-hemodialysis-patients-with-prosthetic-graft-outflow-stenosis
#19
Hsuan-Tzu Yang, Sheng-Yueh Yu, Ta-Wei Su, Tsung-Chi Kao, Hung-Chang Hsieh, Po-Jen Ko
BACKGROUND: Hemodialysis graft outflow stenosis is a significant complication occurring in hemodialysis patients with prosthetic grafts for vascular access. Balloon angioplasty remains the first-line endovascular treatment of this complication, although covered stent graft implantation after balloon angioplasty also appears to be an effective and promising treatment. The aim of this study was to evaluate the efficacy and durability of stent graft placement after balloon angioplasty in comparison to balloon angioplasty alone for the treatment of graft outflow stenosis in hemodialysis patients...
April 2, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29618823/oxygen-extraction-ratio-oer-as-a-measurement-of-hemodialysis-hd-induced-tissue-hypoxia-a-pilot-study
#20
Silverio Rotondi, Lida Tartaglione, Maria Luisa Muci, Alessio Farcomeni, Marzia Pasquali, Sandro Mazzaferro
HD tissue hypoxia associates with organ dysfunctions. OER, the ratio between SaO2 and central-venous-oxygen-saturation, could estimate oxygen requirements during sessions, but no data are available. We evaluated OER behavior in 20 HD patients with permanent central venous catheter (CVC) as vascular access. Pre-HD OER (33.6 ± 1.4%; M ± SE) was higher than normal (range 20-30%). HD sessions increased OER to 39.2 ± 1.5% (M ± SE; p < 0.05) by 30' and to 47.4 ± 1.5% (M ± SE; p < 0...
April 4, 2018: Scientific Reports
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