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https://www.readbyqxmd.com/read/28429519/the-incidence-and-costs-of-bacteremia-due-to-lack-of-gentamicin-lock-solutions-for-dialysis-catheters
#1
Tze Liang Goh, Jason Wei, David Semple, John Collins
The use of antibiotic lock solutions as prophylaxis for catheter-associated blood stream infection (CRBSI) has been shown to be effective in previous randomized controlled trials. However, the cost-effectiveness of this approach had not been studied. In 2012, the routine gentamicin-heparin lock solution used in Auckland City Hospital was withdrawn from the market, leading to a change to heparin-only lock. This was then replaced with gentamicin-citrate lock in 2014. This situation allowed review of the CRBSI rate and financial impact of different catheter lock solutions...
June 2017: Nephrology
https://www.readbyqxmd.com/read/28422870/case-report-the-first-case-of-achromobacter-xylosoxidans-related-tunnel-infection-in-a-patient-receiving-peritoneal-dialysis
#2
Jun-Li Tsai, Shang-Feng Tsai
RATIONALE: Achromobacter xylosoxidans infection is mostly reported in immunocompromised patients. Until now, it is still rarely reported in patients undergoing peritoneal dialysis. PATIENT CONCERNS: This is the 1st case of A xylosoxidans infection due to tunnel infection of a Tenckhoff catheter. DIAGNOSIS: The diagnosis was confirmed by the report of culture. INTERVENTIONS: Risk factors for this infection in peritoneal dialysis include uremia with an immunocompromised state, contamination due to inexperienced skills, and aqueous environment of the dialysate...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28410367/nitric-oxide-charged-catheters-as-a-potential-strategy-for-prevention-of-hospital-acquired-infections
#3
David Margel, Mark Mizrahi, Gili Regev-Shoshani, Mary Ko, Maya Moshe, Rachel Ozalvo, Liat Shavit-Grievink, Jack Baniel, Daniel Kedar, Ofer Yossepowitch, David Lifshitz, Andrei Nadu, David Greenberg, Yossef Av-Gay
BACKGROUND: Catheter-Associated Hospital-Acquired Infections (HAI's) are caused by biofilm-forming bacteria. Using a novel approach, we generated anti-infective barrier on catheters by charging them with Nitric Oxide (NO), a naturally-produced gas molecule. NO is slowly released from the catheter upon contact with physiological fluids, and prevents bacterial colonization and biofilm formation onto catheter surfaces. AIMS AND METHODS: The aim of the study was to assess the anti-infective properties of NO-charged catheters exposed to low concentration (up to 103 CFU/ml) of microbial cells in-vitro...
2017: PloS One
https://www.readbyqxmd.com/read/28409042/nephrologists-hate-the-dialysis-catheters-a-systemic-review-of-dialysis-catheter-associated-infective-endocarditis
#4
Kalyana C Janga, Ankur Sinha, Sheldon Greenberg, Kavita Sharma
A 53-year-old Egyptian female with end stage renal disease, one month after start of hemodialysis via an internal jugular catheter, presented with fever and shortness of breath. She developed desquamating vesiculobullous lesions, widespread on her body. She was in profound septic shock and broad spectrum antibiotics were started with appropriate fluid replenishment. An echocardiogram revealed bulky leaflets of the mitral valve with a highly mobile vegetation about 2.3 cm long attached to the anterior leaflet...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28408711/a-randomized-controlled-trial-to-determine-the-appropriate-time-to-initiate-peritoneal-dialysis-after-insertion-of-catheter-timely-pd-study
#5
Dwarakanathan Ranganathan, George John, Edward Yeoh, Nicola Williams, Barry O'Loughlin, Thin Han, Lakshman Jeyaseelan, Ramanathan Kavitha, Helen Healy
♦Background: The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter insertion is unclear. If dialysis is started too soon after insertion, dialysate leaks and infection could occur. However, by starting PD earlier, morbidity and costs can be reduced through lesser hemodialysis requirements. This is the first randomized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion. ♦ Methods: All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial...
April 13, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28399042/pre-end-stage-renal-disease-visit-to-visit-systolic-blood-pressure-variability-and-post-end-stage-renal-disease-mortality-in-incident-dialysis-patients
#6
Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Kunihiro Yamagata, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
OBJECTIVES: Higher SBP visit-to-visit variability (SBPV) has been associated with increased risk of adverse events in patients with chronic kidney disease, but the association of SBPV in advanced nondialysis-dependent chronic kidney disease with mortality after the transition to end-stage renal disease (ESRD) remains unknown. METHODS: Among 17 729 US veterans transitioning to dialysis between October 2007 and September 2011, we assessed SBPV calculated from the SD of at least three intraindividual outpatient SBP values during the last year prior to dialysis transition (prelude period)...
April 10, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28390069/antimicrobial-agents-for-preventing-peritonitis-in-peritoneal-dialysis-patients
#7
REVIEW
Denise Campbell, David W Mudge, Jonathan C Craig, David W Johnson, Allison Tong, Giovanni Fm Strippoli
BACKGROUND: Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents. However, the effectiveness of these strategies has been variable and are based on a small number of randomised controlled trials (RCTs)...
April 8, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28360371/capd-catheter-exit-site-and-tunnel-infection-with-fungal-etiology-treatment-and-catheter-reinsertion-for-an-extremely-rare-complication
#8
Manmeet Singh Jhawar, Jasmin Das, Pratish George, Anil Luther
Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management-especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter...
March 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28360368/the-pull-technique-for-removal-of-peritoneal-dialysis-catheters-a-call-for-re-evaluation-of-practice-standards
#9
Marvin Grieff, Elizabeth Mamo, Gina Scroggins, Alexander Kurchin
♦ BACKGROUND: The most commonly used peritoneal dialysis (PD) catheters have silicon tubing with attached Dacron cuffs. The current standard of care for PD catheter removal is by complete surgical dissection, withdrawing both the tubing and the cuffs. The intention is to avoid infection of any residual part of the catheter. We retrospectively analyzed our results with the alternative 'pull' technique, by which the silicon tube is pulled out, leaving the Dacron cuffs within the abdominal wall. This technique never gained popularity due to concern that the retained cuffs would get infected...
March 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28356667/hemophagocytic-lymphohistiocytosis-secondary-to-hemodialysis-catheter-related-blood-stream-infection
#10
U Anandh, S Johari, B Vaswani
A 57-year-old man on dialysis presented with fever due to Pseudomonas septicemia. Workup revealed very high triglycerides and serum ferritin levels. A bone marrow examination showed hemophagocytosis. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made and steroids were started. He was put on automated peritoneal dialysis. Patients' condition continued to deteriorate and he succumbed to his illness. This case illustrates the development of HLH secondary to infections which are increasingly being recognized in the literature...
March 2017: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/28355409/life-saving-vascular-access-in-vascular-capital-exhaustion-single-center-experience-in-intra-atrial-catheters-for-hemodialysis
#11
Marta Pereira, Noélia Lopez, Iolanda Godinho, Sofia Jorge, Estela Nogueira, Fernando Neves, Alice Fortes, António G Costa
INTRODUCTION: Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. OBJECTIVE: To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. METHODS: The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center...
March 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/28352029/the-mystery-of-the-nonfunctioning-catheter-an-unusual-complication-of-peritoneal-dialysis-outflow-failure
#12
Pramod K Guru, Beth Piraino
Noninfectious complications of peritoneal dialysis (PD) remain an important impediment to successful implementation of PD. Rare noninfectious complications of the PD catheter are sparsely reported. We report an unusual complication of outflow failure due to a peritoneal catheter that separated into two distinct intra-abdominal segments, due to an unusual method of placement in which two catheters were connected to make a long intra-abdominal portion to permit a high exit site on the abdominal wall. The application of this unusual rather a unique technique led to separation of the two catheter portions and the outflow failure shortly after the patient started continuous ambulatory PD...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28339647/detection-of-human-immunodeficiency-virus-1-ribonucleic-acid-in-the-peritoneal-effluent-of-renal-failure-patients-on-highly-active-antiretroviral-therapy
#13
Kwazi C Z Ndlovu, Wilbert Sibanda, Alain Assounga
Background.: We evaluated the shedding of human immunodeficiency virus (HIV)-1 particles into continuous ambulatory peritoneal dialysis (CAPD) effluents of HIV-positive patients with end-stage renal disease (ESRD). Methods.: A total of 58 HIV-positive patients with ESRD on highly active antiretroviral therapy (HAART) who had Tenckhoff catheters inserted between September 2012 and February 2015 were prospectively reviewed and followed for 18 months. Peritoneal dialysis (PD) effluent samples from functioning CAPD catheters and plasma samples were obtained at three points during regular clinic visits on days 45 ± 37, 200 ± 19 and 377 ± 13 after catheter insertion...
April 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28297057/dialysis-access-issues-related-to-conversion-from-peritoneal-dialysis-to-hemodialysis-and-vice-versa
#14
Maurizio Gallieni, Antonino Giordano, Anna Ricchiuto, Davide Gobatti, Maurizio Cariati
ABSTRACTHemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28296195/evaluation-of-the-infection-risk-in-dialysis-and-chronic-kidney-disease-patients-using-an-atp-monitoring-assay
#15
Junichi Kusano, Rei Kato, Hiroto Matsuda, Yoshikazu Hara, Yoshiaki Fujii, Shinya Suzuki, Masao Sekiyama, Eiki Ando, Kentaro Sugiyama, Toshihiko Hirano
The ATP monitoring assay is a useful biomarker for risk monitoring to detect infection and rejection episodes in transplant recipients. Hemodialysis patients have a higher rate of infectious mortality. Infections in hemodialysis patients are mainly caused by venous catheters, uremia, malnutrition and inflammation. However, the risk of infection episodes has not been evaluated using a lymphocyte ATP monitoring assay in hemodialysis and chronic kidney disease (CKD) patients. We measured the ATP amounts in the peripheral CD4+ cells of CKD (N = 85) and dialysis patients (N = 17) using an "Immuknow" assay kit...
March 13, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28237984/effect-of-a-quality-improvement-program-to-improve-guideline-adherence-and-attainment-of-clinical-standards-in-dialysis-care-report-of-outcomes-in-year-1
#16
Sajeda Youssouf, Azri Nache, Chandrakumaran Wijesekara, Rachel J Middleton, David Lewis, Aladdin E Shurrab, Edmond O'Riordan, Lesley P Lappin, Donal O'Donoghue, Philip A Kalra, Janet Hegarty
BACKGROUND: Best practice in dialysis is synthesised in clear international guidelines. However, a large gap remains between the international guidelines and the actual delivery of care. In this paper, we report outcomes for the first year of a multifaceted dialysis improvement programme in our network. METHODS: One year collaborative involving 3 haemodialysis units and a peritoneal dialysis (PD) programme involving 299 dialysis patients. Each unit addressed a different indicator (unit A - catheter-related bloodstream infection [CRBSI], unit B - pre-dialysis blood pressure [BP], unit C - dialysis dose, unit D - anaemia) with a shared aim to match the top 10% in the UK...
February 25, 2017: Nephron
https://www.readbyqxmd.com/read/28229483/venous-hemodialysis-catheters-and-cardiac-implantable-electronic-devices-avoiding-a-high-risk-combination
#17
EDITORIAL
Theodore F Saad, Henry L Weiner
End-stage renal disease is frequently accompanied by cardiac comorbidity that warrants treatment with a cardiovascular implantable electronic device (permanent pacemaker or implantable cardioverter-defibrillator). In the United States, chronic hemodialysis (HD) population, cardiac implantable devices are present in up to 10.5% of patients; a venous HD catheter is utilized for blood access in 18% of prevalent patients. The concomitant presence of a venous HD catheter and cardiovascular implantable device creates a high-risk circumstance, with potential for causing symptomatic central venous stenosis, and for developing complicated endovascular infection...
February 23, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28218354/dialysis-access-infections-and-hospitalisations-in-unplanned-dialysis-start-patients-results-from-the-options-study
#18
Anna Machowska, Mark D Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul R Qureshi, Bengt Lindholm, Peter Rutherford
INTRODUCTION: Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients. METHODS: In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients...
February 11, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28183858/comparison-of-topical-chlorhexidine-and-mupirocin-for-the-prevention-of-exit-site-infection-in-incident-peritoneal-dialysis-patients
#19
Htay Htay, David W Johnson, Sin Yan Wu, Elizabeth L Oei, Marjorie Wai Yin Foo, Jason C Choo
♦ Objective: Prevention of exit-site infection (ESI) is of paramount importance to peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effectiveness of chlorhexidine in the prevention of ESI in incident PD patients compared with mupirocin. ♦ Methods: This retrospective, pre-test/post-test observational study included all incident PD patients at Singapore General Hospital from 2012 to 2015. Patients received daily topical exit-site application of either mupirocin (2012 - 2013) or chlorhexidine (2014 - 2015) in addition to routine exit-site cleaning with 10% povidone-iodine...
February 9, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28176480/de-novo-thrombotic-microangiopathy-following-simultaneous-pancreas-and-kidney-transplantation-managed-with-eculizumab
#20
REVIEW
Lani Shochet, John Kanellis, Ian Simpson, Joseph Ta, William Mulley
Thrombotic microangiopathy (TMA) is a well-recognised complication following transplantation, often due to an underlying genetic predisposition, medications or rejection. The use of eculizumab in these settings has been previously described, but its role still remains to be clarified. A 45-year-old man, with a history of type 1 diabetes mellitus and subsequent end-stage kidney failure, presented for a simultaneous pancreas-kidney transplant. Immunologically, he was well matched with the donor, and he received standard induction immunosuppression including tacrolimus...
February 2017: Nephrology
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