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Vascular access for Hd

Takeo Ishii, Yasunobu Suzuki, Takuji Nakayama, Miki Ohmori, Shinichi Masai, Naru Sasagawa, Kunio Ohyama
OBJECTIVE: To determine if duplex ultrasound (US) for arteriovenous fistulas (AVFs) can predict vascular events (VEs; thrombosis and stenosis). METHODS: Duplex US was performed for vascular access evaluation in 2557 maintenance hemodialysis (HD) patients between October 1, 2013 and March 31, 2016. Of these patients, 2184 patients were finally included in this study. AVF dysfunction was assessed using the brachial artery blood flow volume (Qa; mL/min), arterial blood flow resistance index (RI), and residual diameter of the fistula vein (RD; mm)...
September 27, 2016: Journal of Vascular Access
Hoon Suk Park, Youn Hee Lee, Hyung Wook Kim, Jun Hyun Baik, Yong Sung Won, Cheol Whee Park, Young Ok Kim, Chul Woo Yang, Dong Chan Jin
Introduction To increase the rate of arteriovenous fistula (AVF) use, assisted procedures for immature AVF have been strenuously performed. However, this is controversial in that an AVF matured by these assisted procedures may require more frequent intervention to maintain its patency, and have decreased long-term patency. Methods Eighty four AVFs that were matured with assisted maturation procedures and 266 AVFs that matured spontaneously without intervention, created between November 2009 and March 2013 from the hemodialysis (HD) vascular access (VA) cohort, were compared retrospectively and we also investigated the factors that may influence AVF long-term patency...
October 6, 2016: Hemodialysis International
Andrew I Chin, Kathleen Tong, John P McVicar
Heart failure necessitating left ventricular assist device (LVAD) support can lead to kidney failure requiring dialysis. Some of these patients may require long-term hemodialysis (HD). Optimal vascular access for a patient on long-term HD therapy with an LVAD remains a complex issue. The majority of LVADs are of the continuous-flow type, and it has been theorized that native arteriovenous fistula maturation may be impaired in a setting of decreased pulsatile arterial flow. We describe a case of successful creation and use of an arteriovenous fistula in an HD-dependent patient with a continuous-flow LVAD...
September 27, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Carlo Basile, Luigi Vernaglione, Francesco Casucci, Pasquale Libutti, Piero Lisi, Luigi Rossi, Valentina Vigo, Carlo Lomonte
BACKGROUND: Satisfactory vascular access flow (Qa) of an arteriovenous fistula (AVF) is necessary for haemodialysis (HD) adequacy. The aim of the present study was to further our understanding of haemodynamic modifications of the cardiovascular system of HD patients associated with an AVF. The main objective was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV). METHODS: All HD patients treated in our dialysis unit and bearing an AVF were enrolled into the present observational cross-sectional study...
October 2016: Clinical Kidney Journal
Tammy Hod, Alexander S Goldfarb-Rumyantzev, Bhanu K Patibandla, Akshita Narra, Robert S Brown
BACKGROUND: In patients with failure of an initial arteriovenous fistula (AVF), a subsequent vascular access is needed before hemodialysis (HD) initiation. METHODS: To assess the optimal access strategy after a failed AVF, we linked data from the US Renal Data System with Medicare claims data identifying 21,436 patients ≥ 67 years old who started HD between January 1, 2005, and December 31, 2008, with an AVF placed as their first predialysis access. Of the 10,568 subjects whose AVF failed, 1,796 patients had an AVF placed as a second access predialysis (AVF2 group) and 399 patients had an arteriovenous graft placed as a second access predialysis (AVG2 group)...
November 2016: Clinical Nephrology
E Mancini, C Perazzini, L Gesualdo, F Aucella, A Limido, F Scolari, S Savoldi, M Tramonti, L Corazza, M Atti, S Severi, P Bolasco, A Santoro
BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH...
August 29, 2016: Journal of Nephrology
Michael V Rocco
BACKGROUND: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. SUMMARY: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed...
December 2015: Kidney Diseases
Mariana Murea, John Burkart
Vascular access preparation in the elderly with advanced kidney disease needs a nuanced approach. Recent studies indicate that age, along with comorbidity, modify the outcomes associated with the type of access placed or used for hemodialysis (HD). Options ranging from permanent vascular access (arteriovenous fistula [AVF] or graft [AVG]) to tunneled central venous catheter (TCVC) or conservative medical care must be weighed on an individual basis and reassessed longitudinally. The potential benefits derived from AVF compared with AVG and TCVC are not always seen in this population...
August 1, 2016: Journal of Vascular Access
V Premuzc, V Ivkovic, N Leko, Z Stipancic, T Teskera, M Vinkovic, M Barisic, S Karanovic, A Vrdoljak, I Vukovic, Z Dika, M Laganovic, B Jelakovic
OBJECTIVE: Early vascular aging (EVA) is a feature of chronic kidney disease(CKD) and pulse wave velocity(PWV) is independent predictor of premature cardiovascular(CV) mortality. High blood pressure(BP) and vascular calcifications contribute mostly to EVA in this group. Endemic nephropathy(EN), an environmental form of aristolochic acid nephropathy, is a chronic tubulointerstitial salt wasting nephropathy characterized with later onset and milder forms of hypertension (HT), and in line with this we hypothesized that arterial stiffness progresses slowlier in EN pts resulting in lower CV mortality...
September 2016: Journal of Hypertension
Tamara Jemcov, Nada Dimkovic
PURPOSE: Adequate and functional long-term vascular access (VA) is pivotal for the efficient hemodialysis (HD). It has been shown that the most reliable VA is autogenous arteriovenous fistulas (AVFs) as compared with arteriovenous grafts (AVGs) and vascular catheters (VCs). The vascular access register (VAR) has been established since 2010, and the 4-year trend of VA in Serbia is presented in this paper. METHODS: All HD centers in Serbia provided their data by fulfilling the questionnaire that included prevalent and incident HD patients on December 31, 2010-1013...
July 27, 2016: International Urology and Nephrology
Mohammad Rezapour, Somayeh Taran, Mahmood Balin Parast, Morteza Khavanin Zadeh
BACKGROUND: Vascular Access (VA) is an important aspect for blood circulatory in Hemodialysis (HD). Arteriovenous Fistula (AVF) is a suitable procedure to gain VA. Maturation of the AVF is a status of AVF, which can be cannulated for HD. This study aimed to discover the parameters that effectively reduce the duration between VA and start of HD, which symbolizes the maturation time (MT). METHODS: Ninety-six patients who underwent AVF creation were selected for this study...
2016: Medical Journal of the Islamic Republic of Iran
Hyo Jin Kim, Hajeong Lee, Dong Ki Kim, Kook-Hwan Oh, Yon Su Kim, Curie Ahn, Jin Suk Han, Seung-Kee Min, Sang-Il Min, Hyo-Cheol Kim, Kwon Wook Joo
BACKGROUND: Vascular access (VA) is essential for hemodialysis (HD) patients, and its dysfunction is a major complication. However, little is known about outcomes in patients with recurrent VA dysfunction. We explored the influence of recurrent VA dysfunction on cardiovascular (CV) events, death and VA abandonment. METHODS: This is a single-center, retrospective study conducted in patients who underwent VA surgery between 2009 and 2014. VA dysfunction was defined as VA stenosis or thrombosis requiring intervention after the first successful cannulation...
2016: American Journal of Nephrology
Anand Devraj, Venkata Siva Tez Pinnamaneni, Manisha Biswal, Raja Ramachandran, Vivekanand Jha
Introduction Staphylococcal infection of endogenous origin is an important cause of morbidity and mortality in patients who receive hemodialysis (HD). The risk of such infections in nasal carriers of the organism is well defined. Extranasal carriage of the organism at extranasal sites may pose similar risks. Methods A total of 70 patients about to undergo internal jugular vein catheterization for HD were enrolled in this prospective observational study. Swab cultures were obtained from anterior nares, posterior pharynx, axillae, toe web spaces, and vascular access sites at baseline and 1 week later...
June 29, 2016: Hemodialysis International
Roberto Ferraresi, Jorge Acuña-Valerio, Matteo Ferraris, Marco Fresa, Meneme Hamade, Gian B Danzi, Roberto Gandini, Giovanni Mauri
BACKGROUND: Critical hand ischemia (CHI) is a not rare condition in patients with end-stage-renal-disease on hemodialysis (HD), and presents devastating consequences due to its impact on life quality. In HD patients CHI may be related to three main conditions: obstruction of the big upper limb arteries, obstruction of the small hand and finger arteries, and the steal effect of a hemodialysis access. The aim of this study was to describe the angiographic pattern of upper limb vascularization and associated cardiovascular risk factors, in a large cohort of consecutive HD patients with CHI studied in our center...
December 2016: Minerva Cardioangiologica
Gregor Novljan, Rina R Rus, Vladimir Premru, Rafael Ponikvar, Nina Battelino
When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction...
June 2016: Therapeutic Apheresis and Dialysis
Patrícia Barreto, Paulo Almeida, Norton de Matos, José Alexandre Queirós, Joaquim Pinheiro, Fernanda Silva, Telmo Carvalho, Rui Almeida, António Cabrita
PURPOSE: Hemodialysis (HD) is the main treatment modality in stage 5 chronic kidney disease, and vascular access planning is a crucial step in the path to dialysis treatment. Beyond detailed patient history and physical examination, duplex ultrasound (DU) evaluation is essential in preoperative vascular mapping. METHODS: A retrospective descriptive nonrandomized study was performed and included 108 end-stage kidney disease patients referred from eight HD centers to be assessed for creation of an arteriovenous (AV) access (AV fistula or AV graft)...
July 12, 2016: Journal of Vascular Access
Awad Magbri, Patricia McCartney, Eussera El-Magbri, Mariam El-Magbri, Taha El-Magbri
BACKGROUND & OBJECTIVES: Access monitoring and pre-emptive angioplasty is known to decrease the incidence of AVF/AVG thrombosis. The effect on increase the longevity and functionality of Arterial-Venous access (AV access) in end-stage renal disease (ESRD) patients is not settled. Thrombosis is the leading cause of vascular access complications and is almost always associated with the presence of stenosis. Percutaneous transluminal angioplasty (PTA) is an accepted treatment of stenotic lesions in AV access (NKF 2001)...
2016: Global Journal of Health Science
Badreddine Ben Kaab, Rania Kheder, Héla Jbali, Wided Smaoui, Madiha Krid, Lamia Raies, Lilia Ben Fatma, Souméya Béji, Med Karim Zouaghi, Fatma Ben Moussa
BACKGROUND: Vascular access is a basic and essential tool required for performing renal replacement therapy in end stage renal disease. AIM: To study the indications of tunneled catheter (KTT) in hemodialysis (HD), identify complications related to the use of KTT and contributing factors, assess the survival and performance of the technique. INTRODUCTION: The making of a vascular access is an angular piece for adequate HD and in good conditions...
December 2015: La Tunisie Médicale
Yu-Wei Chen, Yu-Te Wu, Jhin-Shyaun Lin, Wu-Chang Yang, Yung-Ho Hsu, Kuo-Hua Lee, Shou-Ming Ou, Yung-Tai Chen, Chia-Jen Shih, Pui-Ching Lee, Chia-Hao Chan, Ming-Yi Chung, Chih-Ching Lin
Hemodialysis (HD) is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF) is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a multicenter, cross-sectional study to evaluate the association between genetic polymorphisms of renin-angiotensin-aldosterone system and AVF malfunction...
2016: International Journal of Molecular Sciences
Christiana Oluwatoyin Amira, Babawale Taslim Bello, Rotimi Williams Braimoh
Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved...
May 2016: Saudi Journal of Kidney Diseases and Transplantation
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