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Vascular access for hemodialysis

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https://www.readbyqxmd.com/read/28067467/coronal-mode-ultrasound-guided-hemodialysis-cannulation-a-pilot-randomized-comparison-with-standard-cannulation-technique
#1
Lalathaksha Kumbar, Vivek Soi, Elizabeth Adams, Cheryl Brown Deacon, Mohamed Zidan, Jerry Yee
Background Infiltrations from cannulation result in significant morbidity including loss of hemodialysis (HD) vascular access (VA). Cannulation is dependent on personnel skill and VA characteristics. Surface marking of VA lacks real-time information and traditional ultrasound (US) devices are large, expensive, requiring skilled operators. Sonic Window© (Analogic Ultrasound, Peabody, MA, USA) is a coronal mode ultrasound device (CMUD) approved for VA cannulation. Methods Single center randomized, prospective pilot study comparing handheld US-guided cannulation of new arteriovenous fistula (AVF) to standard cannulation practices...
January 9, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28064472/arteriovenous-grafts-much-maligned-but-in-need-of-reconsideration
#2
Michael Allon
There are substantial variations in arteriovenous fistula (AVF) use among hemodialysis patients in different countries, in different regions of the U.S., and even in different hemodialysis units within a single metropolitan area. These variations persist after adjustment for patient demographics and comorbidities, suggesting that practice patterns play a major role in determining the frequency of AVF use. These observations led to vascular access guidelines urging nephrologists and surgeons to increase AVF creation in patients with chronic kidney disease...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28055065/effect-of-fish-oil-supplementation-and-aspirin-use-on-arteriovenous-fistula-failure-in-patients-requiring-hemodialysis-a-randomized-clinical-trial
#3
Ashley B Irish, Andrea K Viecelli, Carmel M Hawley, Lai-Seong Hooi, Elaine M Pascoe, Peta-Anne Paul-Brent, Sunil V Badve, Trevor A Mori, Alan Cass, Peter G Kerr, David Voss, Loke-Meng Ong, Kevan R Polkinghorne
Importance: Vascular access dysfunction is a leading cause of morbidity and mortality in patients requiring hemodialysis. Arteriovenous fistulae are preferred over synthetic grafts and central venous catheters due to superior long-term outcomes and lower health care costs, but increasing their use is limited by early thrombosis and maturation failure. ω-3 Polyunsaturated fatty acids (fish oils) have pleiotropic effects on vascular biology and inflammation and aspirin impairs platelet aggregation, which may reduce access failure...
January 3, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28045952/predictive-factors-of-one-year-mortality-in-a-cohort-of-patients-undergoing-urgent-start-hemodialysis
#4
Luciene P Magalhães, Luciene M Dos Reis, Fabiana G Graciolli, Benedito J Pereira, Rodrigo B de Oliveira, Altay A L de Souza, Rosa M Moyses, Rosilene M Elias, Vanda Jorgetti
BACKGROUND: Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality...
2017: PloS One
https://www.readbyqxmd.com/read/28045669/long-term-outcomes-of-successful-endovascular-therapy-via-the-retrograde-approach-for-below-the-knee-chronic-total-occlusion-in-patients-with-critical-limb-ischemia-after-a-failed-antegrade-approach
#5
Junya Matsumi, Takuma Takada, Noriaki Moriyama, Tomoki Ochiai, Kazuki Tobita, Koki Shishido, Kazuya Sugitatsu, Shingo Mizuno, Futoshi Yamanaka, Masato Murakami, Yutaka Tanaka, Saeko Takahashi, Takeshi Akasaka, Shigeru Saito
OBJECTIVE: This study evaluated long-term results following successful endovascular therapy (EVT) for chronic total occlusion (CTO) below the knee (BTK) using the retrograde approach after a failed antegrade approach. METHODS: Nineteen patients (19 limbs) with critical limb ischemia (CLI) who underwent successful EVT for BTK-CTO using the retrograde approach after a failed antegrade approach during 2010-2014 were studied. RESULTS: Mean duration of the follow-up period was 25...
January 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28042558/long-term-outcomes-of-arteriovenous-grafts-for-hemodialysis-in-lower-extremities
#6
Seok Han, Dan Song, Sangchul Yun
PURPOSE: The lower extremity has received its fair share of attention as a vascular access site in patients who have exhausted their upper arm vessels. However, experiences with lower extremity arteriovenous grafts (AVGs) have so far been disappointing because of high infection rates and severe limb ischemia. We report our experience with hemodialysis access from the lower extremity. MATERIALS AND METHODS: A retrospective review of 60 lower extremity AVGs created between January 2003 and December 2011 was performed...
December 2016: Vascular Specialist International
https://www.readbyqxmd.com/read/28031406/complications-of-the-arteriovenous-fistula-a-systematic-review
#7
Ahmed A Al-Jaishi, Aiden R Liu, Charmaine E Lok, Joyce C Zhang, Louise M Moist
The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes...
December 28, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28027819/mortality-and-readmission-of-outcomes-after-discharge-from-the-surgical-intensive-care-unit-to-long-term-acute-care-hospitals
#8
Michelle C Nguyen, David S Strosberg, Teresa S Jones, Ankur Bhakta, Edward L Jones, Michael R Lyaker, Cindy A Byrd, Carly Sobol, Daniel S Eiferman
BACKGROUND: Patients with prolonged hospitalizations in the surgical intensive care unit often have ongoing medical needs that require further care at long-term, acute-care hospitals upon discharge. Setting expectations for patients and families after protracted operative intensive care unit hospitalization is challenging, and there are limited data to guide these conversations. The purpose of this study was to determine patient survival and readmission rates after discharge from the surgical intensive care unit directly to a long-term, acute-care hospital...
December 24, 2016: Surgery
https://www.readbyqxmd.com/read/28027805/variations-in-outcomes-of-hemodialysis-vascular-access-by-race-ethnicity-in-the-elderly
#9
Karen Woo, Laura Gascue, Dana P Goldman, John A Romley
OBJECTIVE: Prevalence of end-stage renal disease, modality of treatment, and type of hemodialysis vascular access used varies widely by race/ethnicity in the United States, but outcomes of hemodialysis vascular access by race/ethnicity are poorly described. The objective of this study is to evaluate variations in outcomes of hemodialysis vascular access in the elderly by race/ethnicity. METHODS: Medicare outpatient, inpatient, and carrier files were queried from 2006 to 2011 for beneficiaries that were age ≥66 years and dialysis-dependent at time of index fistula/graft creation, qualified for Medicare by age only, and were continuously enrolled in Medicare 12 months before and after index fistula/graft creation...
December 24, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28001173/patient-in-chronic-hemodialysis-with-right-atrial-mass-thrombus-fungal-endocarditis-or-atrial-myxoma
#10
Talita G Salani, Cynthia de Moura Borges, Carolina S Urbini, Patrícia Schincariol, Kélcia Rosana da Silva Quadros, Maria Almerinda Ribeiro-Alves, Rodrigo Bueno de Oliveira
We present the case report of a 19-year-old patient with chronic kidney disease due to chronic glomerulonephritis, in hemodialysis (HD) by central catheter, with the incidental finding of a mass of 28x16 mm in right atrium (RA). The diagnosis of thrombus, infective endocarditis or myxoma were considered. Given the context of immunosuppression and difficult access vascular therapeutic practice has proved complex. Although Doppler echocardiography suggested thrombus in RA, nuclear magnetic resonance imaging (MRI) indicated for the diagnosis of myxoma in RA...
December 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/27993572/chills-during-hemodialysis-prediction-and-prevalence-of-bacterial-infections-a-retrospective-cohort-study
#11
D Shepshelovich, D Yelin, Bach L Or, N Halevy, Y Ziv, H Green, B Rozen-Zvi, H Ben-Zvi, J Bishara, A Gafter-Gvili, D Yahav
INTRODUCTION: Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established and empirical broad spectrum antibiotics are usually the rule. METHODS: We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection...
December 16, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27991478/hemodialysis-delivery-dialysis-dose-achievement-and-vascular-access-types-in-hemodialysis-patients-from-the-gulf-cooperation-council-countries-enrolled-in-the-dialysis-outcomes-and-practice-patterns-study-phase-5-2012-2015
#12
Anas AlYousef, Sumaya AlGhareeb, Jamal Al Wakeel, Saeed M G Al-Ghamdi, Brian A Bieber, Mohamad Hassan, Yacoub Al Maimani, Naser Alkandari, Haroun Z Ahmed, Ashraf Fawzy, Ronald L Pisoni
The prospective observational Dialysis Outcomes and Practice Patterns Study (DOPPS) was initiated in late 2012 in national samples of hemodialysis (HD) units (n = 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For many years, guidelines have recommended single pool Kt/V ≥1.2 as the minimum adequate dose for chronic HD patients. Here, we report initial DOPPS results regarding HD practices related to dialysis dose achievement in the GCC...
November 2016: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/27984318/systemic-inflammatory-response-syndrome-is-not-an-indicator-of-bateremia-in-hemodialysis-patients-with-native-accesses-a-multicenter-study
#13
Daisuke Uchida, Sho Sasaki, Hiroo Kawarazaki, Masahito Miyamoto, Atsushi Nomura, Kenichiro Koitabashi, Hiroki Nishiwaki, Yugo Shibagaki
Bloodstream infection (BSI) in hemodialysis (HD) patients is often difficult to diagnose. Systemic inflammatory response syndrome (SIRS) is a sensitive predictor of BSI in the general population. We aimed to assess the usefulness of SIRS in predicting BSI in HD patients.We designed a multi-center retrospective observational study of adult (age > 18 years) HD patients who underwent 2 sets of blood cultures for suspected BSI at first hospital visit from August 2011 to July 2012. Clinical, biological, and microbial data were evaluated to evaluate SIRS as a predictor of BSI upon initial presentation to the hospital...
December 13, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27964855/a-case-of-brachiocephalic-fistula-steal-and-the-emergency-physician-s-approach-to-hemodialysis-arteriovenous-fistula-complications
#14
Erica Simon, Brit Long, Kyle Johnston, Shane Summers
BACKGROUND: Chronic kidney disease is common in the United States, with many patients maintained on hemodialysis (HD). The process of HD requires vascular access through an arteriovenous (AV) fistula, AV graft, or central venous catheter. Today, as a result of the National Kidney Foundation's "Fistula First" initiative, nearly 55% of HD patients utilize an AV fistula. As there is significant morbidity and mortality associated with fistula placement and recurrent fistula cannulation, emergency physicians must be equipped to recognize and treat fistula complications...
December 10, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27957414/current-characteristics-of-dialysis-therapy-in-korea-2015-registry-data-focusing-on-elderly-patients
#15
REVIEW
Dong-Chan Jin, Sung-Ro Yun, Seoung Woo Lee, Sang-Woong Han, Won Kim, Jongha Park
Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics...
December 2016: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/27951576/future-trends-in-vascular-access-creation
#16
Surendra Shenoy
Delivery of a prescribed dialysis dose, which is critical for longevity on hemodialysis, is directly dependent on vascular access (VA). However, VA is fraught with high failure rates and has room for innovation. Arteriovenous fistula (AVF), considered the 'best choice', has a high 'failure to mature' rate. Arteriovenous grafts (AVGs) are considered when patients are poor candidates for or have failed AVF, but have a high incidence of infections and thrombosis. Due to associated morbidity and mortality from complications, central venous catheters are considered only as 'bridging short-term access' when there is an urgent need for dialysis...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951575/clearance-gap-does-it-really-matter-for-the-evaluation-of-vascular-access-function
#17
Jun-Ichi Ono, Yujiro Shiraga, Fumika Yoshikawa, Yoshisuke Haruna, Tamaki Sasaki, Seiichi Mochizuki
BACKGROUNDS: Vascular access (VA) stenosis increases the risk of VA obstruction due to the gradual progress of intimal thickening. Therefore, we should try to detect VA stenosis early. However, we do not have a cutoff for when a difference between prescribed Kt/V and delivered Kt/V reflects a clinical issue. Thus, we have devised a new index, the 'clearance gap' (CL-Gap), which quantifies the difference between the effective clearance (eCL) of a hemodialysis (HD) patient and the theoretical clearance (tCL) of a dialyzer to detect a decrease in dialysis efficiency due to VA dysfunction...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951558/evolution-of-technology-for-continuous-renal-replacement-therapy-forty-years-of-improvements
#18
Claudio Ronco
Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27911463/vascular-access-types-in-patients-starting-hemodialysis-after-failed-kidney-transplant-does-close-nephrology-follow-up-matter
#19
Naveed Ul Haq, Mohamed Said Abdelsalam, Mohammed Mahdi Althaf, Abdulrahman Ali Khormi, Hassan Al Harbi, Bader Alshamsan, Mamdouh Nasser Albaqumi, Dieter Clemens Broering, Lutfi Alkorbi, Hassan Ali Aleid
BACKGROUND: Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation...
November 28, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27911460/retrospective-comparison-of-two-different-approaches-for-ultrasound-guided-internal-jugular-vein-cannulation-in-hemodialysis-patients
#20
Antonio Treglia, Dario Musone, Francesco Amoroso
BACKGROUND: Prevalent hemodialysis patients with vascular access consisting of a central venous catheter (CVC) are continuously increasing over the years. Improvement in evolution and CVC placement procedures represents therefore an essential tool to enhance performance and reduce intraoperative and long-term CVC complications. Internal jugular vein (IJV) catheterization techniques are different according to ultrasound probe position in relation to vein axis and to needle direction in relation to ultrasound beam...
December 2, 2016: Journal of Vascular Access
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