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Vascular access for hemodialysis

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https://www.readbyqxmd.com/read/28535525/expanded-hemodialysis-a-new-therapy-for-a-new-class-of-membranes
#1
Claudio Ronco, Gaetano La Manna
A wide spectrum of molecules is retained in end-stage kidney disease, normally defined as uremic toxins. These solutes have different molecular weights and radii. Current dialysis membranes and techniques only remove solutes in the range of 50-15,000 Da, with limited or no capability to remove solutes in the middle to high molecular weight range (up to 50,000 Da). Improved removal has been obtained with high cut-off (HCO) membranes, with albumin loss representing a limitation to their practical application...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28534129/insomnia-muscular-cramps-and-pruritus-have-low-intensity-in-hemodialysis-patients-with-good-dialysis-efficiency-low-inflammation-and-arteriovenous-fistula
#2
Olga Hilda Orasan, Aniela Pop Saplontai, Angela Cozma, Simona Racasan, Ina Maria Kacso, Crina Claudia Rusu, Diana Moldovan, Dacian Tirinescu, Alina Potra, Ioan Mihai Patiu, Remus Aurel Orasan
INTRODUCTION: Insomnia, muscular cramps, pruritus and postdialysis recovery time (RT) are quality-of-life parameters that affect hemodialysis (HD) patients physically and mentally. METHODS: We included 171 end-stage renal disease patients: 115 on high-flux HD and 56 on online hemodiafiltration (HDF). Patients were asked "How long does it take you to recover from a dialysis session?" and they evaluated intensity (absent, mild, medium and severe) of insomnia, muscular cramps and pruritus in the past 4 weeks...
May 22, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28527110/a-review-of-the-hemodynamic-factors-believed-to-contribute-to-vascular-access-dysfunction
#3
Connor V Cunnane, Eoghan M Cunnane, Michael T Walsh
A vascular access (VA) is used to facilitate hemodialysis in patients that suffer from end-stage renal disease. However, they suffer from high failure rates due to non-maturation and venous stenosis, with intimal hyperplasia (IH) the underlying cause of both conditions. Abnormal hemodynamic profiles, which arise following VA creation, are believed to lead to the development of IH. However, the exact physiological response that initiates this process is unknown. This review evaluates the different hemodynamic parameters that are hypothesised to correlate with the development of IH...
May 19, 2017: Cardiovascular Engineering and Technology
https://www.readbyqxmd.com/read/28522650/examining-the-association-between-hemodialysis-access-type-and-mortality-the-role-of-access-complications
#4
Pietro Ravani, Robert Quinn, Matthew Oliver, Bruce Robinson, Ronald Pisoni, Neesh Pannu, Jennifer MacRae, Braden Manns, Brenda Hemmelgarn, Matthew James, Marcello Tonelli, Brenda Gillespie
BACKGROUND AND OBJECTIVES: People receiving hemodialysis to treat kidney failure need a vascular access (a fistula, a graft, or a central venous catheter) to connect to the blood purification machine. Higher rates of access complications are considered the mechanism responsible for the excess mortality observed among catheter or graft users versus fistula users. We tested this hypothesis using mediation analysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied incident patients who started hemodialysis therapy from North America, Europe, and Australasia (the Dialysis Outcomes and Practice Patterns Study; 1996-2011)...
May 18, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28514785/effect-of-age-on-the-association-of-vascular-access-type-with-mortality-in-a-cohort-of-incident-end-stage-renal-disease-patients
#5
Tarek Saleh, Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Geeta G Gyamlani, Elani Streja, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND/AIMS: All hemodialysis (HD) patients are generally recommended to create a fistula first; but to create a mature arteriovenous fistula (AVF) can be challenging in elderly individuals. It is unclear if elderly incident HD patients derive a survival benefit from an AVF over an arteriovenous graft (AVG) or a tunneled central venous catheter (TDC). METHODS: We examined the association of vascular access type (AVF, AVG, and TDC with and without a maturing AVF/AVG at dialysis transition) at HD initiation with all-cause, cardiovascular (CV), and infection-related mortality in 46,786 US veterans using Cox models with adjustment for confounders...
May 18, 2017: Nephron
https://www.readbyqxmd.com/read/28498647/association-between-staphylococcus-aureus-bacteremia-and-hospital-mortality-in-hemodialysis-patients-with-bloodstream-infection-a-multicenter-cohort-from-japanese-tertiary-care-centers
#6
Takahiro Imaizumi, Takeshi Hasegawa, Atsushi Nomura, Sho Sasaki, Hiroki Nishiwaki, Takaya Ozeki, Hideaki Shimizu, Shun Minatoguchi, Taishi Yamakawa, Masahiko Yazawa, Daisuke Uchida, Hiroo Kawarazaki, Masahito Miyamoto, Tomo Suzuki, Ken'ichiro Koitabashi, Masahide Furusho, Yoshiro Fujita
Multiple studies have shown that Staphylococcus aureus bacteremia (SAB) has been a major cause of death in hemodialysis patients. We examined whether SAB is a risk for mortality among chronic hemodialysis patients in Japan where the standard vascular access is arteriovenous fistula (AVF). This was a multicenter, retrospective study of maintenance hemodialysis patients with bloodstream infection (BSI) from 2011 to 2013 at tertiary care centers in Japan. The endpoint was hospital mortality. Our cohort contained 32 SAB cases (14 MRSA and 18 MSSA) and 42 non-SAB cases...
May 12, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28489644/an-open-source-ultrasound-software-for-diagnosis-of-fistula-maturation
#7
Barry Belmont, Dae Woo Park, William F Weitzel, Albert J Shih
Vascular access is essential for hemodialysis patients. The mature native arteriovenous fistula has been the preferred vascular access for hemodialysis, because it has greater longevity than synthetic grafts. However, once surgically created, fistulas often fail to develop (mature) into viable points of vascular access, requiring surgical or radiologic interventions before their use. Because maturation depends on vascular mechanics (e.g., distensibility and wall shear), we developed open-source ultrasound software to investigate these metrics clinically...
May 8, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28486230/the-rise-of-expanded-hemodialysis
#8
Claudio Ronco
The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility...
May 10, 2017: Blood Purification
https://www.readbyqxmd.com/read/28480823/clinical-course-of-hemodialysis-access-after-initial-endovascular-intervention-for-stenosis-in-asian-renal-failure-patients
#9
Dewahar Senthoor, Kyi Zin Thant, Tze-Kiat Ng, Pei Ho
BACKGROUND: Arteriovenous fistula (AVF) and arteriovenous fistula graft (AVG) access for hemodialysis can develop stenosis, eventually leading to thrombosis and access failure. Prompt endovascular intervention can salvage the access but restenosis does occur. Clinical course, restenosis pattern, and risk factors associated with initial stenosis of AVFs/AVGs in Asian hemodialysis patients were studied. METHOD: A retrospective study was conducted (January 2009-June 2012) on consecutive patients with renal failure who developed the first-time stenosis in the vascular access and were managed with endovascular intervention...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28463216/-inadequate-doses-of-hemodialysis-predisposing-factors-causes-and-prevention
#10
Pehuén Fernández, Silvana Núñez, Javier De Arteaga, Carlos Chiurchiu, Walter Douthat, Jorge De La Fuente
Patients receiving sub-optimal dose of hemodialysis have increased morbidity and mortality. The objectives of this study were to identify predisposing factors and causes of inadequate dialysis, and to design a practical algorithm for the management of these patients. A cross-sectional study was conducted. Ninety patients in chronic hemodialysis at Hospital Privado Universitario de Córdoba were included, during September 2015. Twenty two received sub-optimal dose of hemodialysis. Those with urea distribution volume (V) greater than 40 l (72 kg body weight approximately) are 11 times more likely (OR = 11...
2017: Medicina
https://www.readbyqxmd.com/read/28462878/-vascular-steal-syndrome-due-to-the-creation-of-an-arteriovenous-shunt-for-hemodialysis-patient-information-and-nephrologist-responsibility
#11
Alexandre Seidowsky, Eve Vilaine, Sarah Adoff, Emmanuel Dupuis, Caroline Bidault, Cédric Villain, Raphaël Coscas
Although responsibility is a fundamental determinant in medical practice, physicians are generally unfamiliar with its principles. The same is true for disclosure requirements and requests for compensation in the event of physical injury. We report on a representative survey of iatrogenic complications that may arise after the implementation of vascular access for haemodialysis and that illustrate's the physician's responsibility and obligation to inform the patient. Vascular access steal syndrome is a serious complication of arteriovenous fistulas, and physicians may not be sufficiently aware of the likelihood of its occurrence...
April 24, 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28450292/cd44-promotes-inflammation-and-extracellular-matrix-production-during-arteriovenous-fistula-maturation
#12
Go Kuwahara, Takuya Hashimoto, Masayuki Tsuneki, Kota Yamamoto, Roland Assi, Trenton R Foster, Jesse J Hanisch, Hualong Bai, Haidi Hu, Clinton D Protack, Michael R Hall, John S Schardt, Steven M Jay, Joseph A Madri, Shohta Kodama, Alan Dardik
OBJECTIVE: Arteriovenous fistulae (AVF) remain the optimal conduit for hemodialysis access but continue to demonstrate poor patency and poor rates of maturation. We hypothesized that CD44, a widely expressed cellular adhesion molecule that serves as a major receptor for extracellular matrix components, promotes wall thickening and extracellular matrix deposition during AVF maturation. APPROACH AND RESULTS: AVF were created via needle puncture in wild-type C57BL/6J and CD44 knockout mice...
April 27, 2017: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/28445893/early-mortality-associated-with-inpatient-versus-outpatient-hemodialysis-initiation-in-a-large-cohort-of-us-veterans-with-incident-end-stage-renal-disease
#13
Faisal M Arif, Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Jun Ling Lu, Fatima Hassan, Fridtjof Thomas, Omer A Siddiqui, Geeta G Gyamlani, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Mortality in the immediate post-hemodialysis transition period is extremely high. Many end-stage renal disease (ESRD) patients in the US start dialysis in an inpatient setting, but the characteristics of patients starting dialysis as inpatients, and the association of inpatient hemodialysis transition with mortality remain unclear. METHODS: We examined 48,261 US veterans who transitioned to hemodialysis between October 2007 and September 2011. Associations of inpatient hemodialysis starting with all-cause mortality were examined in Cox proportional hazard models, with adjustments for demographics, comorbidities, vascular access type, pre-dialysis nephrology care and medication use, and last pre-ESRD estimated glomerular filtration rate and hemoglobin...
April 27, 2017: Nephron
https://www.readbyqxmd.com/read/28443283/vascular-access-site-for-renal-replacement-therapy-in-acute-kidney-injury-a-post-hoc-analysis-of-the-atn-study
#14
Yue-Harn Ng, Kavitha Ganta, Herbert Davis, V Shane Pankratz, Mark Unruh
BACKGROUND: Acute kidney injury requiring renal replacement therapy (RRT) in the intensive care unit portends a poor prognosis. The decisions regarding dialysis catheter placement is based mainly on physician discretion with little evidence to support the choice of dialysis catheter location. METHODS: The Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was a multicenter, prospective, randomized trial of intensive vs. less intensive RRT in critically ill patients with AKI...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28434704/establishment-of-buttonhole-technique-as-a-puncture-alternative-for-arteriovenous-f%C3%A3-stulas-experience-of-a-centre-over-3years
#15
Laura Baena, José L Merino, Blanca Bueno, Beatriz Martín, Verónica Sánchez, Luca Caserta, Beatriz Espejo, Patricia Domínguez, Alicia Gómez, Vicente Paraíso
INTRODUCTION: The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. PURPOSE: We present 3years' results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. MATERIAL AND METHODS: Twenty-two patients were started on BH technique, 15 men and 7 women (mean age: 62 years; SD: 12), with time spent on dialysis when starting the BH technique of 34 months (SD: 34, median: 27, range: 3-136)...
March 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/28430310/vascular-access-for-hemodialysis-and-tattoos-a-consideration-to-bear-in-mind
#16
Vicent Esteve Simó, Lucia Martínez Carnovale, Lorenzo Álvarez Rodríguez, Ezequiel Paredes Mariñas, Mónica Pou Potau, Antonio De la Torre Morán, Manel Ramírez de Arellano Serna
No abstract text is available yet for this article.
April 18, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28424038/a-novel-method-for-the-treatment-of-bilateral-hypogastric-aneurysms-using-hybrid-polytetrafluoroethylene-graft
#17
Sam Tyagi, D Pineda, H Zheng, M Dougherty, K Calligaro, D Troutman
Open aortic aneurysm repair in the setting of bilateral hypogastric aneurysms is technically challenging. We present a novel technique for open surgical repair for bilateral hypogastric aneurysms using the Gore hybrid vascular graft (GVHG; W. L. Gore and Associates Inc, Flagstaff, Arizona). The GVHG is an expanded polytetrafluoroethylene graft with a nitinol stent at 1 end designed for hemodialysis access. The GVHG has been also been used for aortic debranching and treatment of occlusive disease. We describe the first report using GVHG to repair hypogastric aneurysms...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28421638/renal-replacement-therapy-and-incremental-hemodialysis-for-veterans-with-advanced-chronic-kidney-disease
#18
Kamyar Kalantar-Zadeh, Susan T Crowley, Srinivasan Beddhu, Joline L T Chen, John T Daugirdas, David S Goldfarb, Anna Jin, Csaba P Kovesdy, David J Leehey, Hamid Moradi, Sankar D Navaneethan, Keith C Norris, Yoshitsugu Obi, Ann O'Hare, Tariq Shafi, Elani Streja, Mark L Unruh, Tushar J Vachharajani, Steven Weisbord, Connie M Rhee
Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, the receipt of care within the VA system is associated with favorable outcomes, potentially because of the enhanced access to healthcare resources...
May 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28420654/changes-in-the-profile-of-endovascular-procedures-performed-in-freestanding-dialysis-access-centers-over-15-years
#19
Gerald A Beathard, Aris Urbanes, Terry Litchfield
BACKGROUND AND OBJECTIVES: Marked changes occurred in the vascular access profile of patients receiving hemodialysis in the United States over the 15-year period of 2001-2015. This study was undertaken to evaluate how these changes have affected dialysis access maintenance and salvage procedures performed in freestanding dialysis access centers and to examine the effectiveness, efficiency, and safety of these procedures in this setting. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were collected from freestanding, dedicated dialysis access centers operating under a common system of management...
May 8, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28414565/new-regenerative-vascular-grafts-for-hemodialysis-access-evaluation-of-a-preclinical-animal-model
#20
Karen Tatiana Valencia Rivero, Juliana Jaramillo Escobar, Sergio David Galvis Forero, Maria Clara Miranda Saldaña, Rocío Del Pilar López Panqueva, Néstor Fernando Sandoval Reyes, Juan Carlos Briceño Triana
The purpose of this study was to evaluate a suitable animal model for the in vivo evaluation of patency and vascular tissue regeneration in small intestinal submucosa (SIS) vascular grafts for hemodialysis access. First, a 4-mm U-shaped SIS vascular graft was implanted between the internal carotid artery (CA) and the external jugular vein (JV) in five sheep and six swine. The U-shape grafts remained functional for 53 ± 4 days in sheep and 32 ± 2 days in swine. The sheep model presented exaggerated inflammation, so the swine model was selected for the in vivo study...
April 17, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
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