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Hemodialysis guide

Yoshito Kadoya, Kan Zen, Yohei Oda, Satoaki Matoba
Tip separation of a Crosser catheter is a serious complication; however, there is limited information on bailout methods. Here, we describe a case of successful retrieval of the separated tip of a Crosser catheter using a 2-wire technique with a gooseneck snare. A 76-year-old woman with a history of hemodialysis and diabetes mellitus who developed ulcers on her right toes was diagnosed as having critical limb ischemia and underwent transfemoral antegrade endovascular treatment of the anterior tibial artery (ATA)...
January 1, 2018: Vascular and Endovascular Surgery
Matthew A Weir, Charles A Herzog
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence...
February 26, 2018: Seminars in Dialysis
Derek M Culnan, Kelley Farner, Genevieve H Bitz, Karel D Capek, Yiji Tu, Carlos Jimenez, William C Lineaweaver
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries...
March 2018: Annals of Plastic Surgery
Panagiotis I Georgianos, Eleni Champidou, Vassilios Liakopoulos, Elias V Balaskas, Pantelis E Zebekakis
In the era of newly introduced hypertension guidelines recommending lower blood pressure (BP) targets for drug-treated hypertensives, the necessity for optimized management of hypertension becomes even more urgent. The concept of home BP-guided antihypertensive therapy is for long suggested as a simple and feasible approach to improve BP control rates and optimize the management of hypertension. Home BP-guided antihypertensive therapy is particularly applicable to hypertensives with chronic kidney disease (CKD) for several reasons including the following: (1) difficult-to-control BP and high BP variability in the CKD setting; (2) poor accuracy of office BP in determining hypertension control status and detecting "white-coat" and "masked" hypertension; (3) poor value of routine office BP recordings in predicting the longitudinal progression of target-organ damage; and (4) superiority of home BP over office BP recordings in prognosticating the risk of incident end-stage renal disease or death...
February 10, 2018: Journal of the American Society of Hypertension: JASH
M A Rahil
A pseudoaneurysm or a false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. In hemodialysis fistula, pseudoaneurysm results from repeated puncturing of the vein at the same site. Surgery and endovascular treatment stay widely used as the treatment of pseudoaneurysm compared to the ultrasound-guided manual compression (UGMC). UGMC is a non-invasive and effective procedure which could be attempted before invasive procedures. We reported two cases of successful treatment of pseudoaneurysm by ultrasound-guided compression...
February 2, 2018: Journal of Ultrasound
Brenda R Hemmelgarn, Braden J Manns, Steven D Soroka, Adeera Levin, Jennifer MacRae, Karthik Tennankore, Jo-Anne S Wilson, Robert G Weaver, Pietro Ravani, Robert R Quinn, Marcello Tonelli, Mercedeh Kiaii, Paula Mossop, Nairne Scott-Douglas
BACKGROUND AND OBJECTIVES: Evidence to guide hemodialysis catheter locking solutions is limited. We aimed to assess effectiveness and cost of recombinant tissue plasminogen activator (rt-PA) once per week as a locking solution, compared with thrice weekly citrate or heparin, in patients at high risk of complications. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used a prospective design and pre-post comparison in three sites across Canada. Pre-post comparisons were conducted using multilevel mixed effects regression models accounting for cluster with site and potential enrollment of patients more than once...
January 15, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Anna T Mathew, Joonho Park, Mala Sachdeva, Manish M Sood, Karen Yeates
Background: Aboriginal people in Canada have an unduly high burden of end-stage kidney disease (ESKD) and many live in rural settings. Peritoneal dialysis (PD) is a home-based dialysis modality that may provide a valuable alternative to in-center hemodialysis which is relatively underutilized by the Aboriginal population. Objective: We aim to assess the barriers to PD utilization in Aboriginal patients with ESKD. Design: This article is a prospective observational cohort study...
2018: Canadian Journal of Kidney Health and Disease
Timmy Lee, Missy Magill, Steven K Burke, Andrew T Blair, Michelle L Robbin, Michael Allon
INTRODUCTION: Arteriovenous fistulas (AVF) frequently fail to mature. Postoperative ultrasounds provide objective measurements to predict unassisted AVF use for hemodialysis (unassisted use) and guide interventions to salvage nonmaturing AVFs. The optimal ultrasound criteria to assess AVF maturation are uncertain. We analyzed data from a multicenter, randomized, controlled, clinical trial to compare 2 published ultrasound maturation criteria used to predict unassisted AVF use for hemodialysis...
December 14, 2017: Journal of Vascular Access
Jeffrey E Hull, William C Jennings, Randy I Cooper, Umar Waheed, Matthew E Schaefer, Rajeev Narayan
PURPOSE: To evaluate safety and efficacy of arteriovenous fistulas (AVFs) created with a thermal resistance anastomosis device. MATERIALS AND METHODS: A prospective single-arm trial at 5 sites enrolled 107 patients. Patients underwent ultrasound (US)-guided anastomosis creation between the proximal radial artery and perforating vein with the Ellipsys Vascular Access System (Avenu Medical, Inc, San Juan Capistrano, California) followed by separate maturation procedures...
December 21, 2017: Journal of Vascular and Interventional Radiology: JVIR
Jennifer Day
Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency...
May 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Samer R Abbas, Stephan Thijssen, Erik L Penne, Jochen G Raimann, Li Liu, Murat H Sipahioglu, Eric Seibert, Yuedong Wang, Yuqi Chen, Qingqing Xiao, Nathan W Levin, Peter Kotanko, Fansan Zhu
OBJECTIVE: This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DWcBIS. METHODS: Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment...
November 18, 2017: Journal of Renal Nutrition
Hiroaki Matsuda, Yoshinari Oka, Ryuichi Yoshida, Yuki Katsura, Hidemi Takeuchi, Yasuo Fujimoto, Shigeko Takatsu, Masashi Miyazaki
INTRODUCTION: Arteriovenous access (AVA)-related pain treated successfully with runoff-venous decompression of the causative nerve, following ultrasound (US)-assisted preoperative evaluation, has never been reported. CASE PRESENTATION: A 57-year-old man suffering from constant exhausting pains along the outflow cephalic vein of the radiocephalic arteriovenous fistula at the wrist and the antecubital fossa, was treated surgically after the diagnosis of AVA-related pain derived from cephalic vein compression on two peripheral cutaneous nerves, the superficial radial nerve (SRN) and the lateral antebrachial cutaneous nerve (LACN)...
November 9, 2017: Journal of Vascular Access
Yuka Kamijo, Eiichiro Kanda, Hayato Horiuchi, Noriyuki Kounoue, Keisuke Ono, Keizo Maeda, Akane Yanai, Kazuya Honda, Ryuji Tsujimoto, Mai Yanagi, Yoshitaka Ishibashi, Masayuki Yoshida
BACKGROUND: Patients with end-stage renal disease undergoing hemodialysis (HD) have an elevated risk of cardiovascular disease-related morbidity and mortality. To prevent from such a life-threatening event, the continuous blood pressure (BP) monitoring system may contribute to detect BP decline in early stages and may help to do appropriate disposal. Our research team has introduced an electronic stethoscope (Asahi Kasei Co, Ltd., Tokyo, Japan), which translates sound intensity of Arteriovenous Fistula (AVF) to BP data using the technique of Fourier transformation that can predict continuous BP non-invasively...
November 10, 2017: Clinical and Experimental Nephrology
Bruce M Robinson, Maria Larkina, Brian Bieber, Werner Kleophas, Yun Li, Francesco Locatelli, Keith P McCullough, Jackie G Nolen, Friedrich K Port, Ronald L Pisoni
BACKGROUND: Anemia management protocols in hemodialysis (HD) units differ conspicuously regarding optimal intravenous (IV) iron dosing; consequently, patients receive markedly different cumulative exposures to IV iron and erythropoiesis-stimulating agents (ESAs). Complementary to IV iron safety studies, our goal was to gain insight into optimal IV iron dosing by estimating the effects of IV iron doses on Hgb, TSAT, ferritin, and ESA dose in common clinical practice. METHODS: 9,471 HD patients (11 countries, 2009-2011) in the DOPPS, a prospective cohort study, were analyzed...
November 9, 2017: BMC Nephrology
Fangyi Liu, Xiaoling Yu, Ping Liang, Zhigang Cheng, Zhiyu Han, Jie Yu
PURPOSE: To evaluate the efficacy and safety of ultrasound-guided percutaneous microwave ablation (MWA) for large hepatic cavernous haemangiomas (HCHs) with ablation of the feeding artery and aspiration of blood from haemangioma simultaneously. MATERIALS AND METHODS: From January 2011 to December 2016, 40 patients (29 females, 11male; average age 43.25 ± 7.65 years) with 42 giant hepatic haemangiomas (mean diameter 7.02 ± 1.55 cm, range 4.1-10.8 cm) were treated with image-guided percutaneous MWA with ablation of the feeding artery and aspiration of blood from haemangioma simultaneously...
October 30, 2017: International Journal of Hyperthermia
Kelvin C W Leung, Robert R Quinn, Pietro Ravani, Henry Duff, Jennifer M MacRae
BACKGROUND AND OBJECTIVES: Intradialytic hypotension (IDH) is associated with morbidity. The effect of blood volume-guided ultrafiltration biofeedback, which automatically adjusts fluid removal rate on the basis of blood volume parameters, on the reduction of IDH was tested in a randomized crossover trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a 22-week, single blind, randomized crossover trial in patients receiving maintenance hemodialysis who had >30% of sessions complicated by symptomatic IDH in five centers in Calgary, Alberta, Canada...
November 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
Afsha Aurshina, Enrico Ascher, Anil Hingorani, Natalie Marks
OBJECTIVE: The purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. METHODS: Over a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone...
October 7, 2017: Journal of Vascular Surgery
Bartolo Celona, Chiara Crinò, Elisabetta Giudice, Simona Di Pietro
The aim of this retrospective study was to assess epidemiology and echocardiographic findings of pericardial effusion in canine patients and to determine the clinical usefulness and safety of a new pericardiocentesis technique, using a "fistula needle" for hemodialysis. A database of 5304 dogs of different breeds, age, gender, type, and severity of the cardiac disease, referred for a specialist cardiology and echocardiographic examination from 2009-2016, was reviewed. All the dogs were subjected to echocardiography; when possible and required, an echo-guided pericardiocentesis was performed by mean of a 17G "fistula needle" commonly used for hemodialysis...
June 2017: Topics in Companion Animal Medicine
M Šercl, V Machačka, P Kočí, V Mellanová, L Endrych
INTRODUCTION: Non-maturing arteriovenous fistula is a common problem in hemodialysis units. The main reasons for maturation failure include a poor venous system, vein stenosis, stenosis in an anastomosis, or the presence of collateral veins. Currently, the usual approach to eliminate collateral vein drainage consists in surgical ligation or coil embolization; however, these procedures are time-consuming, logistically demanding and expensive. Alternatively, various types of percutaneous ligation are done...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Ante Mandic, Ivan Cavar, Ivana Skoro, Ivan Tomic, Kristina Ljubic, Slavica Coric, Ivanka Mikulic, Igor Azinovic, Danijel Pravdic
The volume state of dialysis patients is important in guiding the dialysis process. Volume overload in these patients is associated with inflammation. The objectives of the present study were to assess the body composition of patients on hemodialysis; to determine the concentrations of B-type natriuretic peptide (BNP) in plasma and evaluate the association of BNP concentrations with volume overload; to determine the concentrations of C-reactive protein (CRP), albumin and superoxide dismutase (SOD) activities as indicators of inflammatory or antioxidant processes...
December 2017: Therapeutic Apheresis and Dialysis
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