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Vascular access dialysis

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https://www.readbyqxmd.com/read/28721509/maintaining-patency-of-vascular-access-for-haemodialysis
#1
Nicholas Inston, J Al Shakarchi, A Khawaja, R Jones
All types of vascular access, a necessity for haemodialysis, are prone to thrombosis and if untreated this results in failure. Thrombosis results from the combination of impaired blood flow, endothelial and vessel wall injury and a propensity towards pro-coagulative states, either intrinsic or aggravated by dialysis or dehydration. The treatment of access thrombosis relies on removal of the clot (thrombectomy) and treatment of the underlying problem. In most cases this is stenosis secondary to neointimal hyperplasia which can occur early (failure to mature) or later...
July 18, 2017: Cardiovascular Engineering and Technology
https://www.readbyqxmd.com/read/28706868/tricuspid-valve-endocarditis
#2
Syed T Hussain, James Witten, Nabin K Shrestha, Eugene H Blackstone, Gösta B Pettersson
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5-10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors...
May 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28695556/changing-trends-in-end-stage-renal-disease-patients-with-diabetes
#3
Yimin Lu, Christina Stamm, Dina Nobre, Menno Pruijm, Daniel Teta, Anne Cherpillod, Georges Halabi, Olivier Phan, Zina Fumeaux, Roberto Bullani, Thierry Gauthier, Claudine Mathieu, Michel Burnier, Anne Zanchi
BACKGROUND: Worldwide, diabetes has become the most common cause of end-stage renal disease (ESRD), yet Swiss data are largely lacking. METHODS: This observational study examined ESRD patients with diabetes mellitus (ESRD-DM) at end of 2009 and 2014. The prevalence and characteristics of ESRD-DM patients were collected in all dialysis facilities in the Canton of Vaud of Switzerland in 2009 and in 2014, and the 5-year mortality rate was assessed. RESULTS: A total of 107 and 140 ESRD-DM patients underwent dialysis at end of 2009 and 2014, respectively...
July 11, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28681510/impact-of-drugs-on-intradialytic-hypotension-antihypertensives-and-vasoconstrictors
#4
Tara I Chang
Intradialytic hypotension (IDH) is a common complication of hemodialysis and is associated with numerous adverse outcomes including cardiovascular events, inadequate dialysis, loss of vascular access, and death. It is estimated that approximately 20%-30% of all dialysis sessions are affected by IDH. In seeking ways to reduce the occurrence of IDH, dialysis providers often turn to pharmacological approaches: withholding antihypertensive medications prior to hemodialysis or administering vasoconstrictor medications...
July 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28674697/cell-free-vascular-grafts-recent-developments-and-clinical-potential
#5
Sindhu Row, Ana Santandreu, Daniel D Swartz, Stelios T Andreadis
Recent advances in vascular tissue engineering have led to the development of cell-free grafts that are available off-the-shelf for on demand surgery. Challenges associated with cell-based technologies including cell sourcing, cell expansion and long-term bioreactor culture motivated the development of completely cell-free vascular grafts. These are based on decellularized arteries, decellularized cultured cell-based tissue engineered grafts or biomaterials functionalized with biological signals that promote in situ tissue regeneration...
March 2017: Technology
https://www.readbyqxmd.com/read/28673467/fatal-dialysis-vascular-access-hemorrhage
#6
Matthew D Jose, Mark R Marshall, Gail Read, Nicole Lioufas, Jon Ling, Paul Snelling, Kevan R Polkinghorne
Bleeding from dialysis vascular access (arteriovenous fistulas, arteriovenous grafts, and vascular catheters) is uncommon. Death from these bleeds is rare and likely to be under-reported, with incident rates of fewer than 1 episode for every 1,000 patient-years on dialysis, meaning that dialysis units may experience this catastrophic event only once a decade. There is an opportunity to learn from (and therefore prevent) these bleeding deaths. We reviewed all reported episodes of death due to vascular access bleeding in Australia and New Zealand over a 14-year period together with individual dialysis units' root cause analyses on each event...
June 30, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28665465/outcomes-of-a-nephrologist-driven-tunnelled-dialysis-catheter-insertion-service-in-south-east-asia
#7
Milind Nikam, Claude J Renaud, Joshua Shaowen Lee, Sri Fairuz B Saifful, Allen Yan Lun Liu, Eng Kuang Lim, Ying Ying Seow, Lee Ying Yeoh
INTRODUCTION: Tunnelled dialysis catheters (TDCs) are being increasingly inserted by nephrologists globally but there is limited experience and paucity of published outcomes data from South-East Asia (SEA). This study was conducted to analyse the outcomes of TDC insertion by nephrologists from a single centre in SEA. METHODS: All patients who underwent TDC insertion by nephrologists from October 2013 to June 2016 were included. TDC survival was calculated using Kaplan-Meier survival method...
July 14, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28663227/national-healthcare-safety-network-nhsn-dialysis-event-surveillance-report-for-2014
#8
Duc B Nguyen, Alicia Shugart, Christi Lines, Ami B Shah, Jonathan Edwards, Daniel Pollock, Dawn Sievert, Priti R Patel
BACKGROUND AND OBJECTIVES: Persons receiving outpatient hemodialysis are at risk for bloodstream and vascular access infections. The Centers for Disease Control and Prevention conducts surveillance for these infections through the National Healthcare Safety Network. We summarize 2014 data submitted to National Healthcare Safety Network Dialysis Event Surveillance. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Dialysis facilities report three types of dialysis events (bloodstream infections; intravenous antimicrobial starts; and pus, redness, or increased swelling at the hemodialysis vascular access site)...
June 29, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28655387/hemodialysis-treatment-of-cardiorenal-syndrome
#9
Boštjan Leskovar, Tjaša Furlan, Simona Poznič, Maja Potisek, Anton Adamlje
AIMS: We evaluated the impact of hemodialysis on mortality and hospital readmission in patients with cardiorenal syndrome. METHODS: All patients were NYHA IV functional class and underwent laboratory testing, echocardiography, and cardiac functional testing. Hemodialysis was indicated in patients with progressive decline of kidney function and consequent failure to titrate heart failure medication as well as in patients with hypervolemia that was resistant to conservative treatment with more than 4 annual hospitalizations due to heart failure and/or concomitant chronic kidney disease stage III - IV...
June 28, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28648652/dialysis-related-parameters-influence-remodeling-in-the-venous-part-of-the-native-arteriovenous-fistula
#10
Tomasz Gołębiowski, Mariusz Kusztal, Krzysztof Letachowicz, Hanna Augustyniak-Bartosik, Maciej Szymczak, Magdalena Krajewska, Wojciech Marcinkowski, Wacław Weyde, Marian Klinger
AIM: The aim of this study was to evaluate the association of hemodynamic parameters related to hemodialysis and antropometric parameters of patients with changes in the venous part of the arteriovenous fistula (AVF) at points of needling. MATERIAL AND METHODS: 242 HD patients (60.3% men), with median age 65 [IQR 56-75] years, on HD treatment for a median of 49 [IQR 20-88] months with functioning fistula were recruited to the study. The history of vascular access, comorbidity, antropometric (BMI, BSA, body composition) and dialysis-related parameters were analyzed...
June 22, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28647193/cryopreserved-venous-allograft-is-an-acceptable-conduit-in-patients-with-current-or-prior-angioaccess-graft-infection
#11
Michael P Harlander-Locke, Peter F Lawrence, Aamna Ali, Esther Bae, James Kohn, Christopher Abularrage, Michael Ricci, Gary W Lemmon, Sotero Peralta, Jeffrey Hsu
OBJECTIVE: The durability of cryopreserved allograft has been previously demonstrated in the setting of infection. The objective of this study was to examine the safety, efficacy, patency, and cost per day of graft patency associated with using cryopreserved allograft (vein and artery) for hemodialysis access in patients with no autogenous tissue for native fistula creation and with arteriovenous graft infection or in patients at high risk for infection. METHODS: Patients implanted with cryopreserved allograft for hemodialysis access between January 2004 and January 2014 were reviewed using a standardized, multi-institutional database that evaluated demographic, comorbidity, procedural, and outcomes data...
June 21, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28642998/plastic-bronchitis-a-rare-complication-of-long-term-haemodialysis-catheter-placement-in-a-child
#12
Simon Carter, Dayna van de Hoef, Michael Temple, Elizabeth Harvey, Suhail Al-Saleh, Christoph Licht, Damien Noone
BACKGROUND: Despite peritoneal dialysis being the preferred mode of renal replacement therapy in neonates and infants, long-term haemodialysis may be necessary in a minority of patients with its attendant risks. CASE DIAGNOSIS/TREATMENT: This case identifies plastic bronchitis as a rare yet serious complication of long-term large bore vascular access when a vessel-sparing approach is not possible. CONCLUSIONS: An appropriately sized catheter should be used for the dialytic therapy required and to optimize access survival...
June 22, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28638605/effect-of-ethnicity-and-socioeconomic-status-on-vascular-access-provision-and-performance-in-an-urban-nhs-hospital
#13
Teun Wilmink, Anika Wijewardane, Kathryn Lee, Alexander Murley, Lee Hollingworth, Sarah Powers, Jyoti Baharani
BACKGROUND: The aim of this study was to examine the effect of ethnicity, socioeconomic group (SEG) and comorbidities on provision of vascular access for haemodialysis (HD). METHODS: This was a retrospective review of two databases of HD sessions and access operations from 2003-11. Access modality of first HD session and details of transplanted patients were derived from the renal database. Follow-up was until 1 January 2015. Primary failure (PF) was defined as an arteriovenous fistula (AVF) used for fewer than six consecutive dialysis sessions...
February 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28624422/endovascular-proximal-forearm-arteriovenous-fistula-for-hemodialysis-access-results-of-the-prospective-multicenter-novel-endovascular-access-trial-neat
#14
Charmaine E Lok, Dheeraj K Rajan, Jason Clement, Mercedeh Kiaii, Ravi Sidhu, Ken Thomson, George Buldo, Christine Dipchand, Louise Moist, Joanna Sasal
BACKGROUND: Hemodialysis arteriovenous fistulas (AVFs) are suboptimally used primarily due to problems with maturation, early thrombosis, and patient nonacceptance. An endovascular approach to fistula creation without open surgery offers another hemodialysis vascular access option. STUDY DESIGN: Prospective, single-arm, multicenter study (Novel Endovascular Access Trial [NEAT]). SETTINGS & PARTICIPANTS: Consecutive adult non-dialysis-dependent and dialysis-dependent patients referred for vascular access creation at 9 centers in Canada, Australia, and New Zealand...
June 9, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28599902/cost-effectiveness-analysis-of-vascular-access-referral-policies-in-ckd
#15
Steven M Shechter, Talon Chandler, M Reza Skandari, Nadia Zalunardo
BACKGROUND: The optimal timing of vascular access referral for patients with chronic kidney disease who may need hemodialysis (HD) is a pressing question in nephrology. Current referral policies have not been rigorously compared with respect to costs and benefits and do not consider patient-specific factors such as age. STUDY DESIGN: Monte Carlo simulation model. SETTING & POPULATION: Patients with chronic kidney disease, referred to a multidisciplinary kidney clinic in a universal health care system...
June 7, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28589209/bioengineering-in-renal-transplantation-technological-advances-and-novel-options
#16
REVIEW
Wee-Song Yeo, Yao-Chun Zhang
End-stage kidney disease (ESKD) is one of the most prevalent diseases in the world with significant morbidity and mortality. Current modes of renal replacement therapy include dialysis and renal transplantation. Although dialysis is an acceptable mode of renal replacement therapy, it does have its shortcomings, which include poorer life expectancy compared with renal transplantation, risk of infections and vascular thrombosis, lack of vascular access and absence of biosynthetic functions of the kidney. Renal transplantation, in contrast, is the preferred option of renal replacement therapy, with improved morbidity and mortality rates and quality of life, compared with dialysis...
June 6, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28581677/interplay-of-volume-blood-pressure-organ-ischemia-residual-renal-function-and-diet-certainties-and-uncertainties-with-dialytic-management
#17
REVIEW
Ercan Ok, Nathan W Levin, Gulay Asci, Charles Chazot, Huseyin Toz, Mehmet Ozkahya
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume...
June 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28579291/successful-use-of-partial-aneurysmectomy-and-repair-approach-for-managing-complications-of-arteriovenous-fistulas-and-grafts
#18
Shouwen Wang, Michele S Wang
OBJECTIVE: Arteriovenous fistulas and grafts may often be associated with localized complications related to aneurysms/pseudoaneurysms, buttonholes, or structural defects that require proper management to ensure continued access functionality for hemodialysis. Partial aneurysmectomy and repair (PAR) is a targeted surgical approach specifically designed for managing these complications. The basic concepts of PAR include resecting unhealthy or excessive tissue over an access, reconstructing the vascular access lumen using in situ vascular wall or tissue when possible, and closing overlying skin with healthy margins to promote reliable healing...
May 31, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28576453/epidemiology-of-infections-and-antimicrobial-use-in-australian-haemodialysis-outpatients-findings-from-a-victorian-surveillance-network-2008-2015
#19
L J Worth, T Spelman, S G Holt, J A Brett, A L Bull, M J Richards
BACKGROUND: Patients with chronic renal failure who require haemodialysis are at high risk for infections. AIM: To determine the burden of bloodstream and local access-related infections and the prescribing patterns for intravenous antibiotics in Australian haemodialysis outpatients. METHODS: A surveillance network was established following stakeholder consultation, with voluntary participation by haemodialysis centres and data collation by the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre...
May 30, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28575884/predictors-of-clinical-outcomes-in-hemodialysis-patients-a-multicenter-observational-study
#20
Tayebeh Soleymanian, Hossein Niyazi, Shaghayegh Noorbakhsh Jafari Dehkordi, Shokoufeh Savaj, Hassan Argani, Iraj Najafi
INTRODUCTION: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis patients are high despite improvement in dialysis delivery. MATERIALS AND METHODS: Hemodialysis patients (n = 532) from 9 hemodialysis facilities were enrolled in this cohort study in September 2012. Causes of death, hospitalization, and hemodialysis exit were recorded during a 28-month follow-up period. A Cox proportional hazard model was used to predict death adjusting for case-mix variables, nutrition variables, bone mineral variables, Kt/V, vascular access, and Charlson comorbidities index...
May 2017: Iranian Journal of Kidney Diseases
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