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Sample records for hemodialysis catheter function

  1. Hemodialysis Tunneled Catheter Noninfectious Complications

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    Miller, Lisa M.; MacRae, Jennifer M.; Kiaii, Mercedeh; Clark, Edward; Dipchand, Christine; Kappel, Joanne; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; Pike, Pamela; Hiremath, Swapnil

    2016-01-01

    Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined. PMID:28270922

  2. Hemodialysis catheter design and catheter performance: a randomized controlled trial.

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    Van Der Meersch, Hans; De Bacquer, Dirk; Vandecasteele, Stefaan J; Van den Bergh, Barbara; Vermeiren, Pieter; De Letter, Jan; De Vriese, An S

    2014-12-01

    A complication of long-term use of tunneled cuffed catheters for hemodialysis is the high rate of infection and thrombus-related dysfunction. Specific mechanical features of tunneled cuffed catheters may improve hemodynamic performance and decrease thrombosis and infection rates. However, there currently is no proven advantage of one design over another. Single-center randomized clinical trial. 302 hemodialysis patients who required a tunneled cuffed catheter as temporary or definite vascular access. Palindrome Symmetric Tip Dialysis Catheter or HemoStar Long-Term Hemodialysis Catheter. The primary end point was primary assisted patency. Secondary end points were incidence of catheter-related bloodstream infections (CRBSIs), thrombosis, and 2 indicators of rheologic function: mean effective blood flow rate and urokinase use. Mean primary assisted patency was 135.9 days for Palindrome and 136.5 days for HemoStar (P=0.8). Definite CRBSI occurred in 0.24 and 0.10/1,000 catheter-days for Palindrome and HemoStar, respectively (P=0.3). Removal rates for thrombosis that could not be resolved with thrombolysis were 0.53 and 0.43/1,000 catheter-days for Palindrome and HemoStar, respectively (P=0.7). Urokinase use was lower for Palindrome than for HemoStar, as evidenced by a lower number of urokinase infusions/1,000 catheter-days (17 and 35; Pcatheters that never required thrombolysis (58% and 45%; P=0.03). Mean effective blood flow rate was higher for Palindrome than for HemoStar (333 and 304mL/min; Pcatheter types. The Palindrome catheter required less thrombolysis and achieved higher blood flow rates than the HemoStar catheter. These findings suggest that mechanical catheter design may improve catheter rheology, but does not affect risks for thrombosis and infection and hence catheter survival. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Hemodialysis Catheters: How to Keep Yours Working Well

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    ... Events Advocacy Donate A to Z Health Guide Hemodialysis Catheters: How to Keep Yours Working Well Print ... access also see Hemodialysis Access What is a hemodialysis catheter? The catheter used for hemodialysis is a ...

  4. Placement of Hemodialysis Catheters with a Technical, Functional, and Anatomical Viewpoint

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    Zeki Aydin

    2012-01-01

    Full Text Available Aims. Vascular access is of prime importance for hemodialysis patients. We aimed to study early complications of hemodialysis catheters placed in different central veins in patients with acute or chronic renal failure with or without ultrasound (US guidance. Material and Methods. Patients who were admitted to our unit between March 2008 and December 2010 with need for vascular access have been included. 908 patients were examined for their demographic parameters, primary renal disease, and indication for catheterization, type and location of the catheter, implantation technique, and acute complications. Results. The mean age of the patients was 60.6 ± 16.0 years. 643 (70.8 % of the catheters were temporary while 265 (29.2% were permanent. 684 catheters were inserted to internal jugular veins, 213 to femoral, and 11 to subclavian veins. Arterial puncture occurred in 88 (9.7% among which 13 had resultant subcutaneous hematoma. No patient had lung trauma and there had been no need for removal of the catheter or a surgical intervention for complications. US guidance in jugular vein and experience of operator decreased arterial puncture rate. Conclusion. US-guided replacement of catheter to internal jugular vein would decrease complication rate. Referral to invasive nephrologists may decrease use of subclavian vein. Experience improves complication rates even under US guidance.

  5. Median sternotomy for an unexpected complication of permanent hemodialysis catheters: "stuck catheter".

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    Akgun, S; Ak, K; Tugrular, S; Civelek, A; Isbir, C; Arsan, S

    2008-08-01

    Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in patients undergoing hemodialysis. These catheters play an essential role in providing permanent access in patients in whom all other access options have been exhausted. However, they are prone to several complications like catheter thrombosis, catheter fibrin sheating and infection. Herein, we report two uncommon cases of stuck hemodialysis cuffed tunneled catheters causing stenosis and thrombosis in central veins which needed to be removed by median sternotomy.

  6. Catheter related infection in hemodialysis patients

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    Nabi Zahid

    2009-01-01

    Full Text Available To determine the frequency of hemodialysis (HD catheter related infection, causative microorganisms and predisposing factors contributing to these infections at our center, we con-ducted a prospective study in 2007 involving 57 (45.6% males patients in whom a temporary catheter was inserted for HD. The patients were followed for one month to document any episodes of hemodialysis catheter related infection (HCRI. There were 11 (19.3% patients who developed HCRI proven by blood culture; 5 patients were infected with more than one organism. Staphyloco-ccus Coagulase negative and Staphylococcus aureus (S. aureus remain the most common patho-gens. All the organisms were sensitive to antibiotics administered empirically, however, 3 patients developed multiple resistant S. aureus (MRSA. All the infected patients experienced previous epi-sodes of HCRI, which formed a risk factor in addition to low albumin when compared to the non-infected group (P=0.024 and P= 0.001, respectively. We conclude that the rate of HCRI and the causative organisms found in our study is comparable to previous reports. We still need to adopt measures to minimize the use of temporary vascular accesses by creation of fistulas in a timely fashion.

  7. Conversion of tunneled hemodialysis catheter into HeRO device can provide immediate access for hemodialysis.

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    Vasquez, Julio C; DeLaRosa, Jacob; Rahim, Fahim; Rahim, Naeem

    2010-11-01

    Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.

  8. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

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    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  9. Hemodialysis tunneled central venous catheters: five-year outcome analysis.

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    Mandolfo, Salvatore; Acconcia, Pasqualina; Bucci, Raffaella; Corradi, Bruno; Farina, Marco; Rizzo, Maria Antonietta; Stucchi, Andrea

    2014-01-01

    Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement. This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis. Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years. Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.

  10. [Tesio catheters for long-term hemodialysis: our experience in a comarcal hospital].

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    Alvarez Navascués, R; Quiñones, L; Guerediaga, J

    2005-01-01

    Good vascular access remains the cornerstone of effective hemodialysis treatment. The Tesio catheters has been proposed to be a reliable source of vascular access for the dialysis patients. We examined all Tesio catheters inserted over a 3-year period in our hospital. We obtained age, sex, dialysis duration, original nephropaty, vascular access history, complications, dialysis parameters, catheter function duration, confort level for patients and nurses, and death in all our cases. 33 catheters were inserted in 30 patients, 14 male and 16 female. Age 73,92 +/- 9,22 years. Dialysis duration, 25,64 +/- 53,45 months. Diabetic nephropaty 26,66%, NAE 40%, others 33,33%. First vascular access in 13 patients (43,33%), one previously fistula, 5 patients (16,66%), and more of one FAV, 12 patients (40%). We observed two bleeding cases, eight parcial trombosis, one total trombosis (non-function), six tunneled infection and two systemic infection. Only 3 catheters were removal. We obteined good dialysis parameters. Confort state for patients and nurses were satisfactory. Death 12 patients. Catheter function at the moment of study 16,76 +/-12,99 months. We concluded that Tesio catheters can provide excellent long-term vascular access for hemodialysis patients, especially in the older people and with some previous failure fistulas, with low complication rates and acceptable dialysis parameters and tolerance. However, the arteriovenous fistula remains the gold standard for long-term hemodialysis access.

  11. [Infectious complications rate from hemodialysis catheters: experience from the French Polynesia].

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    Leou, Sylvie; Garnier, Fabrice; Testevuide, Pascale; Lumbroso, Catherine; Rigault, Sylvain; Cordonnier, Christophe; Hanf, William

    2013-06-01

    The arterio-venous fistula (AVF) is the most common vascular access to perform hemodialysis (HD). The HD venous central catheter use should only be proposed to old patients and/or patients without vascular access construction feasibility. These HD catheters are often responsible of infectious and thrombosis complications. We performed, for the first time in French Polynesia, a retrospective study based on 214 patients receiving 618 HD catheters, to evaluate the infectious complication rate due to HD catheters. We showed that 17.4% of HD catheters present with infection. The number of bacteraemia due to HD catheters is 2.57/1000 days-catheters and the number of infection due to HD catheter is 1.43/1000 days-catheters. Eighteen percent of patients requiring an emergency HD without AVF access are transferred in intensive care unit due to infectious HD catheter complications. We observed a similar bacteriological environment than in literature. However, the number of tunneled HD catheter is really lower to that of the number required in European recommendations and we observed an abnormal number of non-functional AVF 1 month after creation. These results involve our nephrology unit to increase the number of tunneled catheters to limit the infectious risk and also to fit with the best practices guidelines. Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  12. Association of Peritonitis with Hemodialysis Catheter Dependence after Modality Switch

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    Thamer, Mae; Zhang, Yi; Zhang, Qian; Allon, Michael

    2016-01-01

    Background and objectives Few studies have evaluated vascular access use after transition from peritoneal dialysis to hemodialysis. Our study characterizes vascular access use after switch to hemodialysis and its effect on patient mortality and evaluates whether a peritonitis event preceding the switch was associated with the timing of permanent vascular access placement and use. Design, setting, participants, & measurements The US Renal Data System data were used to evaluate the establishment of a permanent vascular access in 1165 incident Medicare–insured adult patients on dialysis who initiated peritoneal dialysis between July 1, 2010 and June 30, 2011 and switched to hemodialysis within 1 year. Results The proportions of patients using a hemodialysis catheter were 85% (744 of 879), 76% (513 of 671), and 51% (298 of 582) at 30, 90, and 180 days, respectively, after the switch from peritoneal dialysis to hemodialysis. Patients who switched from peritoneal dialysis to hemodialysis with a previous peritonitis episode were more likely to dialyze with a catheter at 30 days (90% [379 of 421] versus 80% [365 of 458]; P=0.03), 90 days (82% [275 of 334] versus 71% [238 of 337]; P=0.03), and 180 days (57% [166 of 289] versus 45% [132 of 293]; P=0.04) after the switch and less likely to dialyze with an arteriovenous fistula at 30 days (8% [32 of 421] versus 16% [73 of 458]; P=0.01), 90 days (13% [42 of 334] versus 23% [76 of 337]; P=0.03), and 180 days (31% [91 of 289] versus 43% [126 of 293]; P=0.04). Patients using a permanent vascular access 180 days after switching from peritoneal dialysis to hemodialysis had better adjusted survival during the ensuing year than those using a catheter (hazard ratio, 0.66; 95% confidence interval, 0.44 to 1.00; P=0.05). Conclusions Among patients who switch from peritoneal dialysis to hemodialysis, prior peritonitis is associated with a higher rate of persistent hemodialysis catheter use, which in turn, is associated with lower

  13. Placement of a Hemodialysis Catheter using the Dilated Right External Jugular Vein as a Primary Route

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    Park, Mi Hyun [Dankook University Hospital, Cheonan (Korea, Republic of); Shin, Byung Seok [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2010-08-15

    To evaluate the feasibility that a dilated right external jugular vein (EJV) could be a primary venous access site for large bore hemodialysis catheter placement. Between January 2008 and April 2009, a total of 173 hemodialysis catheters (14.5 F) were placed. Among them, we evaluated the clinical data of 42 patients who underwent placement through a dilated right EJV. We evaluated technical success, duration of catheterization in days, and the presence of complications. Technical success was achieved for 41 patients (98%). Catheter placement was unsuccessful in one patient due to narrowing of the EJV. The catheter dwell time ranged between 14 and 305 days (mean; 76 days, total catheter days: 3,111 days). A total of 26 hemodialysis catheters were removed due to complications (n=2) and termination of hemodialysis via the hemodialysis catheter (n=24). There was air embolization (n=1) and catheter kinking (n=3) during procedures and catheter related infections (n=2) during the follow-up period. The incidence of catheter related infection was 0.06 per 100 catheter days. No cases of catheter malfunction or symptomatic venous thrombosis were observed. We suggest that a dilated right EJV could be considered as a preferred primary route for hemodialysis catheter placement with easy access

  14. Hemodialysis catheter implantation in the axillary vein by ultrasound guidance versus palpation or anatomical reference

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    Restrepo Valencia CA

    2013-10-01

    Full Text Available Cesar A Restrepo Valencia,1 Carlos A Buitrago Villa,1 Jose A Chacon Cardona21Internal Medicine, Nephrology, 2Epidemiology, Caldas University, Manizales, ColombiaBackground: We compared the results of four different methods of hemodialysis catheter insertion in the medial segment of the axillary vein: ultrasound guidance, palpation, anatomical reference, and prior transient catheter.Methods: All patients that required acute or chronic hemodialysis and for whom it was determined impossible or not recommended either to place a catheter in the internal jugular vein (for instance, those patients with a tracheostomy, or to practice arteriovenous fistula or graft; it was then essential to obtain an alternative vascular access. When the procedure of axillary vein catheter insertion was performed in the Renal Care Facility (RCF, ultrasound guidance was used, but in the intensive care unit (ICU, this resource was unavailable, so the palpation or anatomical reference technique was used.Results: Two nephrologists with experience in the technique performed 83 procedures during a period lasting 15 years and 8 months (from January 1997–August 2012: 41 by ultrasound guidance; 19 by anatomical references; 15 by palpation of the contiguous axillary artery; and 8 through a temporary axillary catheter previously placed. The ultrasound-guided patients had fewer punctures than other groups, but the value was not statistically significant. Arterial punctures were infrequent in all techniques. Analyzing all the procedure-related complications, such as hematoma, pneumothorax, brachial-plexus injury, as well as the reasons for catheter removal, no differences were observed among the groups. The functioning time was longer in the ultrasound-guided and previous catheter groups. In 15 years and 8 months of surveillance, no clinical or image evidence for axillary vein stenosis was found.Conclusion: The ultrasound guide makes the procedure of inserting catheters in the

  15. The economics of hemodialysis catheter-related infection prophylaxis.

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    Kosa, S Daisy; Lok, Charmaine E

    2013-01-01

    Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis. © 2013 Wiley Periodicals, Inc.

  16. Alteplase vs. urokinase for occluded hemodialysis catheter: A randomized trial.

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    Pollo, Viviane; Dionízio, Danielle; Bucuvic, Edwa Maria; Castro, João Henrique; Ponce, Daniela

    2016-07-01

    Introduction Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. To compare the efficacy of alteplase vs. urokinase in reestablishing adequate blood flow through completely occluded vascular catheters. Methods In this randomized study, patients with completely occluded tunneled HD catheters received 40 minutes intracatheter dwell with alteplase (1 mg/mL) or urokinase (5000 IU/mL). Primary endpoint was the proportion of patients with occluded catheters achieving post-thrombolytic blood flow of ≥250 mL/min. Safety endpoints included the incidence of hemorrhagic and infectious complications. Findings Eligible adult patients (n = 100) were treated with alteplase (n = 44) or urokinase (n = 56). The two groups were similar in gender (male: 51.8% vs. 56.8%, P = 0.35), age (60 ± 12 vs. 59 ± 13 years, P = 0.71), time on dialysis (678 ± 203 vs. 548 ± 189 days, P = 0.77), diabetes and cardiovascular disease (55.6% vs. 70.4%, P = 0.08 and 17.8% vs. 22.7%, P = 0.38, respectively), jugular vein as main vascular access (54.8% vs. 62.5%, P = 0.57), and time of CVC (278 ± 63 vs. 218 ± 59 days, P = 0.67). Primary success with alteplase and urokinase occurred in 42/44 (95%) vs. 46/56 (82%), P = 0.06. Success was not achieved after the second dose of alteplase and urokinase in 1 and 7 cases, respectively (2% vs. 12%, P = 0.075). Serious adverse effects were not observed in both groups. There was no difference between the two groups in infectious complications (P = 0.94). Discussion Alteplase and urokinase are effective thrombolytic agents for restoring HD catheter patency. Our study has revealed a likely slight superiority of alteplase over urokinase for unblocking central lines, but which has enrolled too few patients to be able to detect a difference of this size. © 2016 International Society for

  17. Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study

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    Oguzkurt, Levent E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Torun, Dilek; Yildirim, Tuelin; Zuemruetdal, Ayseguel; Kizilkilic, Osman

    2004-12-01

    Objective: To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters. Methods and material: In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared. Results: The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P>0.05). Of the eight patients (14%) with BCV stenosis, two had >50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein. Pericatheter sleeve formation was more frequent in women (P<0.05). However, there were no statistical differences with respect to pericatheter sleeve formation, luminal filling

  18. Hemodialysis catheter implantation in the axillary vein by ultrasound guidance versus palpation or anatomical reference

    OpenAIRE

    Restrepo Valencia CA; Buitrago Villa CA; Chacon Cardona JA

    2013-01-01

    Cesar A Restrepo Valencia,1 Carlos A Buitrago Villa,1 Jose A Chacon Cardona21Internal Medicine, Nephrology, 2Epidemiology, Caldas University, Manizales, ColombiaBackground: We compared the results of four different methods of hemodialysis catheter insertion in the medial segment of the axillary vein: ultrasound guidance, palpation, anatomical reference, and prior transient catheter.Methods: All patients that required acute or chronic hemodialysis and for whom it was determined impossible or n...

  19. A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit.

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    Amira, Christiana Oluwatoyin; Bello, Babawale Taslim; Braimoh, Rotimi Williams

    2016-05-01

    Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days). Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5%) catheters were removed, 14 (20.3%) due to catheter malfunction, eight (11.6%) due to infection, five (7.2%) elective removal, and three (4.3%) due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

  20. Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial.

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    Hermite, Laure; Quenot, Jean-Pierre; Nadji, Abdelouaid; Barbar, Saber David; Charles, Pierre-Emmanuel; Hamet, Maël; Jacquiot, Nicolas; Ghiringhelli, François; Freysz, Marc

    2012-02-01

    Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock in chronic hemodialysis patients suggest it may be efficacious in preventing infection and thrombotic complications. We compared sodium citrate with saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adult patients. Primary endpoint was catheter life span without complication. This was a randomized, controlled, open-label trial involving intensive care patients with acute renal failure requiring hemodialysis. Events were defined as catheter-related bloodstream infection and catheter malfunction. Seventy-eight patients were included. Median catheter life span without complication was 6 days (saline group) versus 12 days (citrate group) [hazard ratio (HR) 2.12 (95% CI 1.32-3.4), p = 0.0019]. There was a significantly higher rate of catheter malfunction in the saline group compared with in the citrate group (127 catheter events/1,000 catheter-days, saline group vs. 26 events/1,000 catheter-days, citrate group, p catheter life span. This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis.

  1. Does antibiotic lock therapy prevent catheter-associated bacteremia in hemodialysis?

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    Macarena Jiménez

    2015-01-01

    Full Text Available Central venous catheter-related blood stream infection is a major cause of morbidity and mortality in patients with renal disease treated with hemodialysis. Antibiotic lock solutions can be effective in preventing this complication in patients with hemodialysis. Searching in Epistemonikos database, which is maintained by screening more than twenty databases, we identified eight systematic reviews including seventeen randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that antibiotic lock solutions probably decrease catheter-related blood stream infection in hemodialysis patients.

  2. Thrombosis caused by polyurethane double-lumen subclavian superior vena cava catheter and hemodialysis

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    Wanscher, Maria Rørbæk; Frifelt, J J; Smith-Sivertsen, C

    1988-01-01

    During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were...

  3. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

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    Soi V

    2016-04-01

    Full Text Available Vivek Soi, Carol L Moore, Lalathakasha Kumbar, Jerry Yee Division of Nephrology and Hypertension, Henry Ford Health System, Detroit, MI, USA Abstract: Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter maintenance, infection control measures, and early removal of devices as patients transition to other access. Despite best efforts, when conservative measures fail to prevent infections in a high-risk population, antimicrobial lock therapy should be considered as an option to combat catheter-related bloodstream infections. Keywords: hemodialysis, CRBSI, catheter, end-stage renal disease, ESRD

  4. Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

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    Burton, Kirsteen R. [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada); Guo, Lancia L. Q. [University of Calgary, Department of Radiology (Canada); Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.on.ca [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada)

    2012-12-15

    Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

  5. Blood flow measurements during hemodialysis vascular access interventions - Catheter-based thermodilution or Doppler ultrasound?

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.Methods: Thirty patients with arteriovenous fistulas who underwent 46 interventions had...... access blood flow measured before and after every procedure. Two methods, catheter-based thermodilution and Doppler ultrasound, were compared to the reference method of ultrasound dilution. Catheter-based thermodilution and Doppler ultrasound were performed during the endovascular procedures while flow...

  6. Retrograde femoral vein catheter insertion. A new approach for challenging hemodialysis vascular access.

    Science.gov (United States)

    Gouda, Zaghloul

    2014-01-01

    Venous catheters provide access for hemodialysis (HD) when patients do not have functioning access device. Obstruction of jugular, femoral or even external iliac vessels further depletes options. Subclavian approach is prohibited. Catheterization of inferior vena cava requires specialized equipment and skills. The purpose is to assess a new lifesaving HD vascular access approach for patients with nonfunctioning access device in the ordinary sites. This entails insertion of a retrograde temporary HD catheter in the superficial femoral vein, directing the catheter distally, toward the foot. We included six end-stage renal disease (ESRD) patients retrospectively who are on regular renal replacement therapy and need urgent HD with nonfunctioning access device in the ordinary sites. Successful insertion of six retrograde femoral vein catheters in the superficial femoral vein. The mean catheter days were 2.5±0.5 days with one patient having 26 catheter days. The mean blood pump speed was 230.0±44.7 mL/min. Urea reduction ratio and Kt/V at 3 hours HD session were 47% and 1.5, respectively, which increased with increasing session duration. The ultrafiltration volume was 2-3 L/session which increased up to 6 L/session in case of using slow low-efficiency dialysis. No major complications were observed during insertion or the postinsertion period except thigh pain in one patient and exit site infection in the case of long duration. This is a newly applied lifesaving HD vascular access approach for selected ESRD patients with no available HD vascular access at the ordinary sites with accepted HD adequacy. It needs more evaluation and more studies.

  7. Radiologic placement of hemodialysis central venous catheters: a practical guide

    Energy Technology Data Exchange (ETDEWEB)

    Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B. [Foothills Hospital, Dept. of Diagnostic Imaging, Calgary, Alberta (Canada)

    2001-04-01

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

  8. Temporary hemodialysis catheter placement by nephrology fellows: implications for nephrology training.

    Science.gov (United States)

    Clark, Edward G; Schachter, Michael E; Palumbo, Andrea; Knoll, Greg; Edwards, Cedric

    2013-09-01

    The insertion of temporary hemodialysis catheters is considered to be a core competency of nephrology fellowship training. Little is known about the adequacy of training for this procedure and the extent to which evidence-based techniques to reduce complications have been adopted. We conducted a web-based survey of Canadian nephrology trainees regarding the insertion of temporary hemodialysis catheters. Responses were received from 45 of 68 (66%) eligible trainees. The median number of temporary hemodialysis catheters inserted during the prior 6 months of training was 5 (IQR, 2-11), with 9 (20%) trainees reporting they had inserted none. More than one-third of respondents indicated that they were not adequately trained to competently insert temporary hemodialysis catheters at both the femoral and internal jugular sites. These findings are relevant to a discussion of the current adequacy of procedural skills training during nephrology fellowship. With respect to temporary hemodialysis catheter placement, there is an opportunity for increased use of simulation-based teaching by training programs. Certain infection control techniques and use of real-time ultrasound should be more widely adopted. Consideration should be given to the establishment of minimum procedural training requirements at the level of both individual training programs and nationwide certification authorities. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  9. Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists.

    Science.gov (United States)

    McQuillan, Rory F; Clark, Edward; Zahirieh, Alireza; Cohen, Elaine R; Paparello, James J; Wayne, Diane B; Barsuk, Jeffrey H

    2015-10-07

    Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention. This pre- post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre- and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct. In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; Pnephrology fellows' skills, with

  10. Effectiveness of sutureless percutaneous placement of cuffed tunneled hemodialysis catheters applying StatLock attachment devices.

    Science.gov (United States)

    Teichgräber, Ulf Karl-Martin; de Bucourt, Maximilian; Gebauer, Bernhard; Streitparth, Florian; Hamm, Bernd; Enzweiler, Christian

    2011-01-01

    A prospective, randomized-controlled trail was conducted to evaluate the effectiveness of securing tunneled hemodialysis (HD) catheters with sutureless StatLock attachment devices (Bard Access Systems) compared to traditional suture fixation. At a university teaching hospital 72 patients with chronic renal failure received cuffed tunneled HD catheters. In the study group (n=36) the HD catheters were secured with a sutureless StatLock attachment device, whereas the control group HD catheters were fixated with sutures only. The intended intermediate use of the tunneled HD catheters was 42 ± 7 days until the arteriovenous fistula was sufficient. All catheters were placed by an interventional radiologist using ultrasound for the puncture of the internal jugular vein. We evaluated the success and complication rate of tunneled catheter implantation. The primary success rate for implantation of HD catheters was 100%. There was an overall complication rate of 8.3% in the study group (one hematoma in the subcutaneous catheter tract and two central venous thromboses). In the control group the overall complication rate was 13.9% (two hematomas, one central venous thrombosis and two catheter displacements). The two catheter displacements required a HD catheter exchange. In addition, four local irritations at the HD catheter entry site were seen only in the control group and were rated as minor complications. The sutureless placement technique is safe and effective with a low complication rate, and is superior to the traditional suture fixation of tunneled catheters.

  11. Update on Insertion and Complications of Central Venous Catheters for Hemodialysis

    Science.gov (United States)

    Bream, Peter R.

    2016-01-01

    Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed. PMID:27011425

  12. Prevalence of infection in patients with temporary catheter for hemodialysis in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Palmiane de Rezende Ramim Borges

    2017-08-01

    Full Text Available This study aimed to determine the prevalence of infection related to the provisional catheter for hemodialysis in a teaching hospital and evaluate the risk factors associated with these infections.  A cross-sectional study analyzed by descriptive statistics and parametric tests. It was found that out of 129 patients, 48.8 % had catheter-related infection in hemodialysis, 65 % were male, 33.3 % were 60 years old and over, and 88 % of patients were admitted to intensive care unit. The prevalence of infection in this group was high, and the vast majority of diagnoses of infection were empirical. Given this, it is suggested to establish the routine culture of the catheter tip in all cases of suspected catheter infection to improve the quality of patient care, and the relentless pursuit of the causes that trigger the infection process in line with good practice from across the healthcare team.

  13. Comparison of Step Tip Type and Split Tip Type Hemodialysis Catheter: HemoGlide Versus the HemoSplit

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Hyun [Dankook University Hospital, Cheonan (Korea, Republic of); Shin, Byung Seok [Chungnam National University, Daejeon (Korea, Republic of)

    2009-08-15

    To evaluate the results and complications of the step tip type and split tip type tunneled hemodialysis catheters. Between March 2008 and December 2008, a total of 147 tunneled hemodialysis catheters of step tip (n=89) and split tip (n=58) type were placed in 126 patients to perform hemodialysis. We evaluated the number of catheterization days, as well as complications with respect to catheter tip types. A tunneled hemodialysis catheter was placed successfully in all cases. The duration of catheterization ranged from 7 to 180 days (mean 68, total catheter days: 10,504 days). A significantly higher complication rate was observed in the step tip type (n=23) as compared to the split tip type (n=4) (p=0.004), especially due to catheter dysfunction and catheter laceration. Five cases of catheter-related infection (3.4%, 0.48/1000 catheter days) were observed. Placement of the tunneled hemodialysis catheter of step tip type and spit tip type were performed safely. However, the split tip type is more useful because of the greater rate of complication in step tip type

  14. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

    Science.gov (United States)

    2013-01-01

    Background Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement. Methods Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association’s Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter–related complications (MCRCs). Results Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter–related complications were most frequently seen in patients 16 years or younger. Conclusions The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters

  15. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V

    2012-01-01

    Purpose: The purpose of this study was to perform bench and clinical testing of a catheter-based intravascular system capable of measuring blood flow in hemodialysis vascular accesses during endovascular procedures. Methods: We tested the Transonic ReoCath Flow Catheter System which uses...... the thermodilution method. A simulated vascular access model was constructed for the bench test. In total, 1960 measurements were conducted and the results were used to determine the accuracy and precision of the catheters, the effects of external factors (e.g., catheter placement, injection duration), and to test....... Blood flow measurements provide unique information on the hemodynamic status of a vascular access and have the potential to optimize results of interventions....

  16. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis.

    Science.gov (United States)

    Landry, Daniel L; Braden, Gregory L; Gobeille, Stephen L; Haessler, Sarah D; Vaidya, Chirag K; Sweet, Stephen J

    2010-10-01

    Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related blood stream infections (CRIs), but there are no data regarding the long-term consequences of this practice. Over a 4-year period, from October 1, 2002, to September 30, 2006, we initiated a gentamicin and heparin lock (GHL) protocol in 1410 chronic hemodialysis patients receiving dialysis through a tunneled catheter in eight outpatient units. Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006. Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.

  17. Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

    Energy Technology Data Exchange (ETDEWEB)

    Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

    2012-09-15

    Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

  18. Can serum NGAL levels be used as an inflammation marker on hemodialysis patients with permanent catheter?

    Science.gov (United States)

    Yigit, Irem Pembegul; Celiker, Huseyin; Dogukan, Ayhan; Ilhan, Necip; Gurel, Ali; Ulu, Ramazan; Aygen, Bilge

    2015-02-01

    Neutrophil gelatinase-associated lipocalin (NGAL) is a member of lipocalin family and released from many tissues and cells. We aimed to investigate the relationship among serum NGAL levels, the inflammation markers (IL-6, hs-CRP, TNF-α) and different vascular access types used in dialysis patients. The study population included 90 patients and 30 healthy age-matched controls. The patients were divided into three groups (I, II, III) and group IV included the controls. In group I and II, the patients were with central venous permanent catheter and arterio-venous fistula, respectively. Group III included 30 patients with chronic renal failure. Hemogram, biochemical assays, ferritin, IL-6, hs-CRP, TNF-α, and NGAL were evaluated in all groups. Serum NGAL levels were markedly higher in group I than in group II (7645.80 ± 924.61 vs. 4131.20 ± 609.87 pg/mL; p < 0.05). Positive correlation was detected between NGAL levels and duration of catheter (r: 0.903, p: 0.000), hs-CRP (r: 0.796, p: 0.000), IL-6 (r: 0.687, p: 0.000), TNF-α (r: 0.568, p: 0.000) levels and ferritin (r: 0.318, p: 0.001), whereas NGAL levels were negatively correlated with serum albumin levels (r: -0.494, p: 0.000). In multiple regression analysis, duration of catheter hs-CRP and TNF-α were predictors of NGAL in hemodialysis patients. Inflammation was observed in hemodialysis patients and increases with catheter. Our findings show that a strong relationship among serum NGAL levels, duration of catheter, hs-CRP and TNF-α. NGAL may be used as a new inflammation marker in hemodialysis patients.

  19. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes.

    Directory of Open Access Journals (Sweden)

    Hari Talreja

    Full Text Available With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data.1 To determine factors associated with catheters becoming embedded and 2 to determine outcomes associated with endoluminal dilatation.All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters.We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years and history of central venous stenosis.Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.

  20. Central venous catheters as a source of hemodialysis-related bacteremia.

    Science.gov (United States)

    Taylor, G D; McKenzie, M; Buchanan-Chell, M; Caballo, L; Chui, L; Kowalewska-Grochowska, K

    1998-09-01

    To describe investigations into an increase in hemodialysis-related bacteremia that occurred in our hospital in the first 6 months of 1996. Hemodialysis unit in a tertiary-care medical center. Prospective surveillance for hemodialysis bacteremia has been performed for several years. Cases that occurred in 1995 were compared to cases in the first 6 months of 1996. Unit data on dialysis runs and method of dialysis access were used to calculate rates. Nested polymerase chain reaction (PCR) was used to type 18 Staphylococcus aureus isolates from 1996. A case-control study comparing 80 randomly selected hemodialysis patients from 1995 and 1996 was performed to examine infection risk factors. The hemodialysis bacteremia rate was 1.2 per 1,000 runs in 1995 and 2.8 per 1,000 in the first 6 months of 1996 (P=.0009). The 25 cases in 1995 and 32 in the first half of 1996 were similar in age, gender, means of vascular access, and microbial etiology. Central venous catheter (CVC) access accounted for >90% of cases in both time periods. S aureus was the most common microbial etiology (53% of the 1996 cases). PCR typing of S aureus isolates from 1996 demonstrated five different strains, the most common having six isolates. The use of CVCs as a means of vascular access abruptly increased in the unit in January 1996, from 40% in 1996 (P<.001), associated with structural changes in healthcare delivery in the region resulting in delays in performing surgical procedures, such as creation of vascular grafts and fistulae. A marked increase in hemodialysis bacteremia occurred in 1996, associated with increased reliance on CVCs for vascular access in hemodialysis patients during a period of healthcare restructuring.

  1. The impact of sodium citrate on dialysis catheter function and frequency of catheter-related bacteriemia and haemorrhage

    Directory of Open Access Journals (Sweden)

    Maciej Szymczak

    2009-10-01

    Full Text Available Vascular access is one of the most important problems of hemodialysis therapy. It is known that an arteriovenous fi sutla provides the best vascular access, but its creation is not always possible. Other solutions, such as the insertion of a central venous catheter, are then required. Adequate protection of such catheters by interdialytic fi ll with locking solution affects the frequency of hemodialysis-related complications. The most widespread catheter locking solution is heparin. Sodium citrate is being used more frequent recently. Available data indicate that hemorrhage is 11.9 times more frequent if the catheter locking solution is 5000 IU/ml heparin than if 4�0sodium citrate or 1000 IU/ml heparin is used. Other data indicate that the frequency of infection is statistically decreased when 30�0sodium citrate is used to fi ll the catheter instead of 5000 IU/ml heparin. Analogous data on 46.7�0sodium citrate are not consistent. It seems that the use of 4�0sodium citrate instead of 5000 IU/ml heparin does not decrease the frequency of infections. Numerous studies indicate that sodium citrate at various concentrations exerts a positive infl lence on catheter function. However, not all data are in accord. The spill of sodium citrate from the catheter to the systemic circulation is connected with a risk of adverse events. It may be dangerous if the citrate concentration is 46.7�20However, adequate fi lling of the catheter should prezent such events. Available data indicate that fi lling of the catheter with a solution of citrate of a concentration of no more than 30�0should be safe. Data on 46.7�0citrate are not conclusive, so precautions should be taken.

  2. A single institutional experience of conversion of non-tunneled to tunneled hemodialysis catheters: a comparison to de novo placement.

    Science.gov (United States)

    Bajaj, Sunil Kumar; Ciacci, Joseph; Kirsch, Matthias; Ebersole, John D

    2013-12-01

    To compare the outcomes of conversion of non-tunneled to tunneled hemodialysis catheters with de novo placement of tunneled catheters and to determine the effect of time to conversion of non-tunneled to tunneled catheters on the incidence of complications. A retrospective data analyses was performed on 1,154 patients who had de novo placement of tunneled hemodialysis catheters (control group) and 254 patients who underwent conversion of non-tunneled to tunneled catheters (study group). The outcomes including technical complications, infection, and catheter dysfunction were compared between the two groups. The technical success rate was 100 % in both the groups with no complications recorded at the time of procedure or within 24 h of insertion. The most common complication encountered in both the groups was catheter dysfunction (15.6 % in controls and 18.1 % in study). Infection rates/100 catheter days for the control and study groups were 0.17 and 0.19, respectively. Infection-free survival was not statistically different between the two groups. The time spent with non-tunneled catheter prior to conversion did not significantly alter the rates of catheter dysfunction and infection in the study group. The efficacy and safety of conversion of non-tunneled to tunneled hemodialysis catheters are similar to de novo placement with no difference in the rates of technical success, catheter dysfunction, or infection. However, the exchange of non-tunneled to tunneled catheter can help in preservation of veins for future vascular access, which is of vital importance in patients with chronic renal disease.

  3. Prospective analysis of Hemodialysis Reliable Outflow (HeRO) vascular access graft vs. cuffed catheter access in hemodialysis.

    Science.gov (United States)

    Provenzano, Robert; LaFleur, Paula; McFadden, Lori; LaFleur, Matthew; Lorelli, David

    2015-11-01

    The Hemodialysis Reliable Outflow (HeRO) graft was compared to the cuffed catheter in end-stage renal disease patients. All consented patients were evaluated for HeRO graft placement. Eligible patients that did not receive a graft were enrolled in the control group. Participants who had not exhausted peripheral venous access sites suitable for fistulas and grafts were excluded. Differences in quality of life and incidence of bacteremia, vascular interventions, hospitalizations, and death were evaluated over one year. In thirty-three patients included in the analysis--16 HeRO, 17 control--significantly fewer bacteremia events (93.8% vs. 64.7%) and a significantly increased number of vascular interventions (64.7% vs. 25%) were reported for the HeRO versus Control group. The increased interventions in the HeRO group may be due to the two-step placement process.

  4. Tinzaparin is safe and effective in the management of hemodialysis catheter thrombosis.

    LENUS (Irish Health Repository)

    Quinlan, Catherine

    2012-08-27

    Children on hemodialysis are at increased risk of thrombosis, especially when dialyzed via a central venous catheter (CVC); there are limited published data regarding the safety and efficacy of tinzaparin in this group. We conducted a retrospective chart review of all children in the National Pediatric Hemodialysis Centre for Ireland diagnosed with a CVC thrombus and treated with subcutaneous tinzaparin over a 10 year period. Seven children were treated with subcutaneous tinzaparin for 10 CVC thrombi. Tinzaparin was commenced at 175 IU\\/kg\\/day and the dose was titrated by measuring anti-factor Xa levels, aiming for levels of 0.3-1.0 IU\\/ml. Treatment was continued until resolution of the CVC thrombus. Restoration of normal flows during dialysis occurred within 3 days in all patients. There were no episodes of bleeding and all children tolerated the treatment well.

  5. Endovascular treatment of an iatrogenic superior vena cava perforation caused by the placement of a hemodialysis catheter: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Kim, Young Hwan; Keum, Dong Yoon [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-01-15

    The perforation of superior vena cava during the placement of a tunneled hemodialysis catheter, via the subclavian vein, is a rare complication, and is manifested by hemothorax or hemopericardium. The treatment of this complication requires an early diagnosis and open thoracic surgery. Herein, we report a patient with hemothorax due to the perforation of the superior vena cava during the placement of a tunneled hemodialysis catheter via the right subclavian vein which was successfully treated by embolization by way of a coil and histoacryl.

  6. Tunneled catheters with taurolidine-citrate-heparin lock solution significantly improve the inflammatory profile of hemodialysis patients.

    Science.gov (United States)

    Fontseré, Néstor; Cardozo, Celia; Donate, Javier; Soriano, Alex; Muros, Mercedes; Pons, Mercedes; Mensa, Josep; Campistol, Josep M; Navarro-González, Juan F; Maduell, Francisco

    2014-07-01

    Mortality and morbidity are significantly higher among patients with dialysis catheters, which has been associated with chronic activation of the immune system. We hypothesized that bacteria colonizing the catheter lumen trigger an inflammatory response. We aimed to evaluate the inflammatory profile of hemodialysis patients before and after locking catheters with an antimicrobial lock solution. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-10, and tumor necrosis factor alpha (TNF-α) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10, and TNF-α were analyzed in peripheral blood mononuclear cells (PBMC). Samples were obtained at baseline and again after 3 months' use of taurolidine-citrate-heparin lock solution (TCHLS) in 31 hemodialysis patients. The rate of catheter-related bloodstream infections (CRBSI) was 1.08 per 1,000 catheter-days in the heparin period and 0.04 in the TCHLS period (P = 0.023). Compared with the baseline data, serum levels of hs-CRP and IL-6 showed median percent reductions of 18.1% and 25.2%, respectively (P profile in hemodialysis patients with tunneled catheters. Further studies are needed to evaluate the potential beneficial effects on clinical outcomes. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  7. Cost of installing and turning off hemodialysis on patients with central venous catheters

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    Gillene Santos Ferreira

    2014-12-01

    Full Text Available The objective was to identify the average total cost (ATC for installing and turning off hemodialysis on patients with central venous catheters. This quantitative, exploratory, and descriptive research, in the mode of a single-case study, was conducted in a public university hospital. The non-probabilistic sample corresponded to the observation of 100 installations and 100 terminations of hemodialysis on 42 patients during 23 days of collection. The ATC was calculated by multiplying the time spent by nurses by the unit cost of direct labor, and adding the cost of materials, solutions, and medications. The Brazilian currency (R$ was used for the calculations. The ATC for installation was R$ 80.10 and for shutting off was R$ 13.04, totaling R$ 93.14 per hemodialysis session. The results obtained will facilitate a better planning of the allocation of human, material, and financial resources enabling the increase of managerial strategies aimed at economic efficiency. doi: 10.5216/ree.v16i4.23044.

  8. Life-saving vascular access in vascular capital exhaustion: single center experience in intra-atrial catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Marta Pereira

    Full Text Available Abstract 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. Results: Seven patients were submitted to twelve IAC placements. Bleeding (6/7 and infections (3/7 were the main complications in the early postoperative period. Two (2/7, 29% patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5. During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60 months and the mean IAC patency was 8 ± 11 (0-34 months. Conclusion: Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.

  9. [Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk].

    Science.gov (United States)

    Izoard, S; Ayzac, L; Meynier, J; Seghezzi, J-C; Jolibois, B; Tolani, M L

    2017-11-01

    International guidelines recommend to limit the long-term use of central-veinous catheters in patients undergoing hemodialysis, because they expose the patient to a higher infectious risk than the fistulas. However, for some patients with comorbidity, switching to a permanent vascular access is not possible. In such case, the catheter is used for a longer period. It seems therefore important to study the influence of a prolonged duration of catheterization on infectious complications. The temporal fluctuation profile of the infectious risk is poorly studied in the literature and the results published may be contradictory. This multicentric prospective study included 1053 incident tunneled catheters. Multivariate logistic regression was used to identify significant risk factors of infection. An infection-free survival analysis was performed afterwards to estimate the variation of the instantaneous infectious risk during catheterization. The major risks factors of infections on tunneled catheters were: previous Staphylococcus aureus infection (aOR=1.95 [1.16-3.27]; P=0.012), diabetes (aOR=1.67 [1.16-2.41]; P=0.006), and long duration of catheterization (0-3months vs.≥24months: aOR=2.42 [1.34-4.36]; P=0.003). The survival analysis showed a higher risk of infections of tunneled catheters during the first months after placement. Risk declines over time. The fluctuation profile of the infectious risk show that preventive precautions should target the first months of catheterization. Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.

  10. Hemodialysis

    Science.gov (United States)

    ... Events Advocacy Donate A to Z Health Guide Hemodialysis Print Email Healthy kidneys clean your blood and ... you when you should start dialysis. How does hemodialysis work? In hemodialysis, a dialysis machine and a ...

  11. Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project.

    Science.gov (United States)

    Apata, Ibironke W; Hanfelt, John; Bailey, James L; Niyyar, Vandana Dua

    2017-03-21

    Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens - CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs. The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units. In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, pphase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65). Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.

  12. Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Rinat, Choni; Ben-Shalom, Efrat; Becker-Cohen, Rachel; Feinstein, Sofia; Frishberg, Yaacov

    2014-11-01

    Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome. We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications. In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.

  13. Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis among Staphylococcus aureus nasal carriers

    Directory of Open Access Journals (Sweden)

    Anil K Saxena

    2012-01-01

    Full Text Available Staphylococcus aureus nasal carriers undergoing hemodialysis (HD through tunneled cuffed catheters (TCCs form a high-risk group for the development of catheter-related bloodstream infections (CRBSI and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA or methicillin-resistant (MRSA S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82 S. aureus nasal carriers dialyzed through TCCs (n = 88 were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (n = 41 "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (n = 47 filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days, P <0.001 and higher infection-free TCC survival rates at 365 days (80.5 vs. 40.4%, P <0.0001 were observed in the cefotaxime group compared with the stan-dard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among S. aureus nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.

  14. A numerical study of the effect of catheter angle on the blood flow characteristics in a graft during hemodialysis

    Science.gov (United States)

    Ryou, Hong Sun; Kim, Soyoon; Ro, Kyoungchul

    2013-02-01

    For patients with renal failure, renal replacement therapies are needed. Hemodialysis is a widely used renal replacement method to remove waste products. It is important to improve the patency rate of the vascular access for efficient dialysis. Since some complications such as an intimal hyperplasia are associated with the flow pattern, the hemodynamics in the vascular access must be considered to achieve a high patency rate. In addition, the blood flow from an artificial kidney affects the flow in the vascular access. Generally, the clinical techniques of hemodialysis such as the catheter angle or dialysis dose have been set up empirically. In this study, a numerical analysis is performed on the effect of the catheter angle on the flow in the graft. Blood is assumed to be a non-Newtonian fluid. According to the high average wall shear stress value, the leucocytes and platelets can be activated not only at the arterial anastomosis, but also at the bottom of the venous graft, when the catheter angle is not zero. For a catheter angle less than five degrees, there is a low shear and high oscillatory shear index region that appears at the venous graft and the venous anastomosis. Thus, a catheter angle less than five degrees should be avoided to prevent graft failure.

  15. Percutaneous Placement of Central Venous Catheters: Comparing the Anatomical Landmark Method with the Radiologically Guided Technique for Central Venous Catheterization Through the Internal Jugular Vein in Emergent Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Koroglu, M.; Demir, M.; Koroglu, B.K.; Sezer, M.T.; Akhan, O.; Yildiz, H.; Yavuz, L.; Baykal, B.; Oyar, O. [Suleyman Demirel Univ., Isparta (Turkey). Depts. of Radiology, Internal Medicine and Anesthesiology

    2006-02-15

    Purpose: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. Material and Methods: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n = 40) were compared with those of the anatomical landmark method (n 40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. Results: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

  16. The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter.

    Science.gov (United States)

    Al-Balas, Alian; Lee, Timmy; Young, Carlton J; Kepes, Jeffrey A; Barker-Finkel, Jill; Allon, Michael

    2017-12-01

    Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We identified 479 patients starting hemodialysis with a CVC at a large medical center (during 2004-2012) who subsequently had an AVF ( n =295) or AVG ( n =105) placed or no arteriovenous access (CVC group, n =71). Compared with patients receiving an AVG, those receiving an AVF had more frequent surgical access procedures per year (1.01 [95% confidence interval, 0.95 to 1.08] versus 0.62 [95% confidence interval, 0.55 to 0.70]; P access procedures per year. Patients receiving an AVF had a higher median annual cost (interquartile range) of surgical access procedures than those receiving an AVG ($4857 [$2523-$8835] versus $2819 [$1411-$4274]; P access procedures was similar in both groups. The AVF group had a higher median overall annual access-related cost than the AVG group ($10,642 [$5406-$19,878] versus $6810 [$3718-$13,651]; P =0.001) after controlling for patient age, sex, race, and diabetes. The CVC group had the highest median annual overall access-related cost ($28,709 [$11,793-$66,917]; P access-related procedures and complications is higher in patients who initially receive an AVF versus an AVG. Copyright © 2017 by the American Society of Nephrology.

  17. Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter. Our 7-Year Experience

    Energy Technology Data Exchange (ETDEWEB)

    Bermudez, Patrícia, E-mail: pbermude@clinic.ub.es [Clinic Hospital of Barcelona, Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute (Spain); Fontseré, Nestor, E-mail: fontsere@clinic.ub.es [Clinic Hospital of Barcelona, Vascular Access Unit, Nephrologic and Urologic Diseases Clinical Institute (Spain); Mestres, Gaspar, E-mail: gmestres@clinic.ub.es [Clinic Hospital of Barcelona, Cardiovascular Diseases Institute (Spain); García-Gámez, Andres, E-mail: garciagam@clinic.ub.es; Barrufet, Marta, E-mail: barrufet@clinic.ub.es; Burrel, Marta, E-mail: mburrel@clinic.ub.es; Gilabert, Rosa, E-mail: gilabert@clinic.ub.es; Gómez, Fernando, E-mail: fegomez@clinic.ub.es; Macho, Juan, E-mail: jmmacho@clinic.ub.es [Clinic Hospital of Barcelona, Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute (Spain)

    2017-02-15

    PurposeTo evaluate the efficacy and safety of the hydrodynamic thrombectomy catheter (AngioJet DVX) in the salvage of thrombosed hemodialysis vascular grafts.Materials and MethodsA retrospective study was designed, including all patients with occluded arteriovenous grafts treated with the AngioJet system between 2007 and 2014 in our institution. Outcomes included technical success, clinical success, complications, and primary and secondary patencies. Procedural success was defined as angiographic confirmation of flow restoration, the presence of a pulsatile thrill along the graft, and successful resumption of at least one hemodialysis session. Primary and secondary patencies after first AVG thrombectomy were calculated with Kaplan–Meier curves. Cox regression was used to determine prognostic factors of primary patency after every thrombectomy episode.ResultsA total of 149 thrombectomies were performed in 68 grafts. After thrombectomy, endovascular treatment of one or more stenosis was performed in all cases. Technical success was 93% and clinical success was 86%. Complications occurred in 7 thrombectomies, most of them were minor except for one anastomosis rupture requiring surgery. Primary and secondary patencies were 52, 41, and 23 and 76, 68, and 57% at 3, 6 and 12 months, respectively. Independent prognostic factors of poor patency after every thrombectomy episode were the presence of residual thrombus (OR 1.831, P = 0.008) and time from last thrombosis (less than 1 month; and OR 7.116, P < 0.001).ConclusionPercutaneous mechanical thrombectomy with AngioJet is a safe technique with a high-clinical success rate. The presence of residual thrombus after thrombectomy and early re-occlusions are related to poorer results.

  18. Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.

    Science.gov (United States)

    Al Shakarchi, Julien; Inston, Nicholas; Jones, Robert G; Maclaine, Grant; Hollinworth, David

    2016-04-01

    In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for

  19. The Burden of Tunneled Central Venous Catheters for Hemodialysis in a County Hospital.

    Science.gov (United States)

    Pillado, Eric; Korn, Abraham; de Virgilio, Christian; Bowens, Nina

    2017-10-01

    Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67.2%) were male, with a mean age of 50.0 ± 12.4 years. Overall 62.5 per cent initiated dialysis via CVC. Patients were divided into two groups (those with CVC (62.5%) and those without (37.5%)). Male gender was associated with initiation of dialysis via CVC versus no CVC (72.5 vs 58.3%, P = 0.02), as was a history of prior vascular access (P < 0.01). There were no significant differences between the groups regarding age, diabetes, smoking, ambulatory status, or insurance status. There were no differences in gender, age, insurance status, or prior vascular access between prolonged CVC use (≥90 days) and short-term CVC use (<90 days). We conclude that most patients initiated HD with CVC and exceed the recommended CVC duration. Men are more likely to initiate HD via CVC. Insurance status was not associated with CVC use. Multidisciplinary action may address barriers to reducing CVC duration.

  20. Relationships between plasma pentraxin 3 levels and inflammation markers patients with tunneled permanent catheter in hemodialysis.

    Science.gov (United States)

    Yigit, Irem Pembegul; Dogukan, Ayhan; Taskapan, Hulya; Comert, Melda; Ilhan, Necip; Ulu, Ramazan; Aygen, Bilge

    2015-01-01

    Vascular access (VA) devices may contribute to chronic inflammation in hemodialysis (HD). Pentraxin 3 (PTX3) is a recently discovered acute phase protein that responds more rapidly than other inflammatory markers. This study compared PTX3 and other markers between HD patients and healthy controls. The study population included 30 patients with tunneled permanent catheter (TPC), 30 patients with arteriovenous fistula (AVF) and 30 healthy controls. Hemogram, biochemical assays, ferritin, high sensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and PTX3 were evaluated in all groups. PTX levels were highest in HD patients with TPC, intermediated in HD patients with AVF and lowest in healthy controls (5.2 + 2.4 vs. 3.1 + 1.3 vs. 1.8 + 0.7, p<0.001 for all comparisons). PTX3 levels correlated strongly to hs-CRP (r = 0.857) and moderately to TNF-α, NLR, ferritin and total neutrophil count. PTX3 and albumin levels had a negative correlation. PTX3 levels were higher in patients with 8 months of TPC than those with 7 months or less. PTX3 levels are significantly elevated in all patients on HD, but presence and extended duration of TPC are associated with incrementally higher levels of PTX3 and other inflammatory markers. PTX3 and NLR may be useful in assessing chronic inflammatory states in HD.

  1. Low-Intensity Adjusted-Dose Warfarin for the Prevention of Hemodialysis Catheter Failure: A Randomized, Controlled Trial

    Science.gov (United States)

    Wilkieson, Trevor J.; Ingram, Alistair J.; Crowther, Mark A.; Soroka, Steven D.; Nagai, Ryuta; Jindal, Kailash K.

    2011-01-01

    Summary Background and objectives To determine whether warfarin prolongs the time to first mechanical-catheter failure. Design, setting, participants, & measurements This was a multicenter parallel-group randomized controlled trial with blinding of participants, trial staff, clinical staff, outcome assessors, and data analysts. Randomization was in a 1:1 ratio in blocks of four and was concealed by use of fax to a central pharmacy. Hemodialysis patients with newly-placed catheters received low-intensity monitored-dose warfarin, target international normalized ratio (INR) 1.5 to 1.9, or placebo, adjusted according to schedule of sham INR results. The primary outcome was time to first mechanical-catheter failure (inability to establish a circuit or blood flow less than 200 ml/min). Results We randomized 174 patients: 87 to warfarin and 87 to placebo. Warfarin was associated with a hazard ratio (HR) of 0.90 (P = 0.60; 95% confidence interval [CI], 0.57, 1.38) for time to first mechanical-catheter failure. Secondary analyses were: time to first guidewire exchange or catheter removal for mechanical failure (HR 0.78; 95% CI, 0.37, 1.6); time to catheter removal for mechanical failure (HR 0.67; 95% CI, 0.19, 2.37); and time to catheter removal for any cause (HR 0.89; 95% CI, 0.42, 1.81). Major bleeding occurred in 10 participants assigned to warfarin and seven on placebo (relative risk, 1.43; 95% CI, 0.57, 3.58; P = 0.61). Conclusions We found no evidence for efficacy of low-intensity, monitored-dose warfarin in preventing mechanical-catheter failure. PMID:21493739

  2. An ethanol/sodium citrate locking solution compared to heparin to prevent hemodialysis catheter-related infections: a randomized pilot study.

    Science.gov (United States)

    Vercaigne, Lavern M; Allan, Don R; Armstrong, Sean W; Zacharias, James M; Miller, Lisa M

    2016-01-01

    The objective of this study was to compare the initial safety and efficacy of a novel 30% ethanol/4% sodium citrate catheter-locking solution to heparin in a hemodialysis population. This was a prospective, randomized, pilot study of 40 hemodialysis patients randomized to a 30% ethanol/4% sodium citrate or heparin 1000 units/mL locking solution. The primary outcome was identification of any serious adverse events over the study duration. Secondary outcomes included the rate per 1000 catheter days for catheter-related bloodstream infections (CRBSI), alteplase use, catheter dysfunction, and catheter removal. Three serious adverse events were reported as possibly related to the catheter solutions. Only one CRBSI was observed during the study in the heparin arm. The rate of alteplase use was 1.5/1000 catheter days in the heparin arm compared to 2.8/1000 catheter days in the ethanol/citrate arm (rate ratio = 1.85, 90% CI 0.48, 7.07, p value = 0.45), while the rate of catheter dysfunction was 6.8/1000 catheter days in the heparin arm compared to 1.9/1000 catheter days in the ethanol citrate arm (rate ratio = 0.27, 90% CI 0.10, 0.74, p value = 0.04). Catheter survival to first catheter outcome was longer in the ethanol/citrate group compared to heparin and there were no catheter removals due to bacteremia or thrombosis. The ethanol/sodium citrate locking solution was safely used in this study. It appears to prevent CRBSI and may improve catheter survival compared to heparin. ClinicalTrials.gov Identifier: NCT01394458.

  3. Placement of long-term hemodialysis catheter (permcath in patients with end-stage renal disease through external jugular vein

    Directory of Open Access Journals (Sweden)

    Ali Akbar Beigi

    2014-01-01

    Full Text Available Background: The number of patients with End-Stage Renal Disease (ESRD has progressively increased in the population. Kidney transplantation is the specific treatment for such patients; however a majority of patients will require hemodialysis before kidney transplantation. The present study aims to investigate using the external jugular vein (EJV for Permcath placement in these patients. Materials and Methods: This descriptive and analytical study was conducted in Alzahra Medical Center, Isfahan, in 2012. Catheters were inserted by cutting down the right EJV. The patency rate and potential complications were studied. The obtained data was analyzed using SPSS 21.0. Results: Out of 45 live patients, within three months of surgery, 40 patients (81.6% had no complications and dialysis continued through Permcath. Permcath Thrombosis occurred in two patients (4.4%. Catheter infection led to the removal of it in one patient (2.2% 1.5 months after surgery. And accidental catheter removal occurred in one patient. Conclusion: Placement of the permcath in the external jugular vein can be a safe, uncomplicated, and reliable method for patients requiring hemodialysis, and can be a life-saving alternative in patients without accessible internal jugular vein.

  4. Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

  5. Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis.

    Science.gov (United States)

    Colì, L; Donati, G; Cianciolo, G; Raimondi, C; Comai, G; Panicali, L; Nastasi, V; Cannarile, D C; Gozzetti, F; Piccari, M; Stefoni, S

    2006-01-01

    Chronic oral anticoagulation is currently used to avoid thrombosis and the malfunction of tunneled cuffed catheters (TCCs) for hemodialysis (HD). The aim of the study was to assess the efficacy of early warfarin administration, after TCC placement, in comparison to its administration after the first thrombosis or malfunction event of the TCC. One hundred and forty-four chronic dialysis patients, who underwent TCC placement between June 2001 and June 2005, were randomized into two groups: 81 patients, group A, started oral anticoagulation 12 hr after the TCC placement (target international normalized ratio (INR) 1.8-2.5), in association with ticlopidine 250 mg/die; 63 patients, group B, started warfarin after the first thrombosis/malfunction episode (target INR 1.8-2.5) in association with ticlopidine 250 mg/die. The efficacy of oral anticoagulation therapy in preventing TCC thrombotic complications was evaluated in a 12-month follow-up period, after TCC placement, in terms of: a) the number of patients with thrombotic-malfunction events; b) the number of thrombotic-malfunction events with urokinase infusion (events/patient/year); c) intradialytic blood flow rate (BFR, ml/min); d) negative blood pressure (BP) from the arterial line of the TCC (AP, mmHg); e) positive BP, in the extracorporeal circuit from the venous line (VP, mmHg); and f) bleeding complications. Ten patients (12%) in group A showed TCC thrombosis/malfunction vs. 33 patients (52%) in group B (p TCC thrombotic complications and an improvement in both arterial and venous fluxes in comparison with the same therapy administered after the first TCC thrombotic/malfunction event. This therapy did not induce any bleeding complications in the patients included in the study.

  6. Evaluation of hand functions in hemodialysis patients.

    Science.gov (United States)

    Tander, Berna; Akpolat, Tekin; Durmus, Dilek; Canturk, Ferhan

    2007-01-01

    Patients with end stage renal disease (ESRD) have many musculoskeletal abnormalities, including hand dysfunction. The Sollerman test evaluates hand grip function in daily activities. The relationships between Sollerman test (dominant hand) with Duruoz's Hand Index (DHI), Health Assessment Questionnaire (HAQ), and Beck Depression Inventory (BDI) tests have not been investigated previously. The aims of this study are to evaluate hand grip function using the Sollerman test in hemodialysis (HD) patients, correlate this test with other measures evaluating hand function or psychosocial status, and investigate factors that can affect Sollerman test. One-hundred twenty HD patients (64 male, 56 female, mean age 51 +/- 1.4 years, mean duration of HD therapy 5.3 +/- 3.7 years) were included in this study. The HAQ, DHI, and BDI scores were determined by standard techniques. All patients underwent the Jamar grip test and Sollerman test for the dominant (D) and non-dominant hand (ND). We found a positive correlation between Sollerman test (dominant hand) with Sollerman test-ND, Jamar-D, and Jamar-ND tests. There were negative correlations between Sollerman test with age, HAQ, BDI, and DHI tests. The relationships between Sollerman test (dominant hand) with DHI, HAQ, and BDI tests have not been investigated previously. This study showed the correlations between the Sollerman test (dominant hand) and other tests (either positive or negative). Psychosocial problems can affect hand functions.

  7. Blood flow in hemodialysis catheters: a numerical simulation and microscopic analysis of in vivo-formed fibrin.

    Science.gov (United States)

    Lucas, Thabata Coaglio; Tessarolo, Francesco; Jakitsch, Victor; Caola, Iole; Brunori, Giuliano; Nollo, Giandomenico; Huebner, Rudolf

    2014-07-01

    Although catheters with side holes allow high flow rate during hemodialysis, they also induce flow disturbances and create a critical hemodynamic environment that can favor fibrin deposition and thrombus formation. This study compared the blood flow and analyzed the influence of shear stress and shear rate in fibrin deposition and thrombus formation in nontunneled hemodialysis catheters with unobstructed side holes (unobstructed device) or with some side holes obstructed by blood thrombi (obstructed device). Computational fluid dynamics (CFD) was performed to simulate realistic blood flow under laminar and turbulent conditions. The results from the numerical simulations were compared with the fibrin distribution and thrombus architecture data obtained from scanning electron microscopy (SEM) and two photons laser scanning microscopy (TPLSM) on human thrombus formed in catheters removed from patients. CFD showed that regions of flow eddies and separation were mainly found in the venous holes region. TPLSM characterization of thrombi and fibrin structure in patient samples showed fibrin formations in accordance with simulated flux dynamics. Under laminar flow conditions, the wall shear stress close to border holes increased from 87.3±0.2 Pa in the unobstructed device to 176.2±0.5 Pa in the obstructed one. Under turbulent flow conditions, the shear stress increased by 47% when comparing the obstructed to the unobstructed catheter. The shear rates were generally higher than 5000/s and therefore sufficient to induce fibrin deposition. This findings were supported by SEM data documenting a preferential fibrin arrangement on side hole walls. Copyright © 2013 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  8. Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution.

    Science.gov (United States)

    Krishnasami, Zipporah; Carlton, Donna; Bimbo, Lisa; Taylor, Maria E; Balkovetz, Daniel F; Barker, Jill; Allon, Michael

    2002-03-01

    Tunneled dialysis catheters are complicated by frequent systemic infections. Standard therapy of catheter-associated bacteremia involves both systemic antibiotics and catheter replacement. Recent data suggest that biofilms in the catheter lumen are responsible for the bacteremia, and that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions can eradicate the biofilm. We analyzed prospectively the efficacy of an antibiotic lock protocol, in conjunction with systemic antibiotics, for treatment of patients with dialysis catheter-associated bacteremia without catheter removal. Protocol success was defined as resolution of fever and negative surveillance cultures one week following completion of the protocol. Protocol failure was defined as persistence of fever or surveillance cultures positive for any pathogen. In addition, infection-free catheter survival was compared to that observed in institutional historical control patients treated with catheter replacement. Blood cultures were positive in 98 of 129 of episodes (76%) in which patients dialyzing with a catheter had fever or chills. Protocol success occurred in 40 of 79 infected patients (51%) treated with the antibiotic lock. Protocol failure occurred in 39 cases (49%): 7 had persistent fever, 15 had positive surveillance cultures (9 for Candida and 6 for bacteria), and 17 required catheter removal due to malfunction. Each of the pathogens in the surveillance cultures was different from the original pathogen in that patient. Eight of the 9 secondary Candida infections and all 6 secondary bacterial infections resolved after catheter exchange and specific antimicrobial treatment. Overall catheter survival with the antibiotic lock protocol was similar to that observed among patients managed with catheter replacement (median survival, 64 vs. 54 days, P = 0.24). Use of an antibiotic lock, in conjunction with systemic antibiotic therapy, can

  9. Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients

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    Brunelli SM

    2014-04-01

    Full Text Available Steven M Brunelli,1 Levi Njord,2 Abigail E Hunt,1 Scott P Sibbel1 1DaVita Clinical Research®, Minneapolis, MN, USA; 2DaVita HealthCare Partners, Inc, Denver, CO, USA Background and objectives: Catheter-related bloodstream infections (CRBSIs are common in hemodialysis patients using central venous catheters, and catheter occlusion also occurs frequently. The Tego needlefree connector was developed to reduce the incidence of these complications; however, existing studies of its effectiveness and safety are limited. Materials and methods: This retrospective analysis compared outcomes among patients of a large dialysis organization receiving in-center hemodialysis using a central venous catheter with either the Tego connector or standard catheter caps between October 1 and June 30, 2013. Incidence rates for intravenous (IV antibiotic starts, receipt of an IV antibiotic course, positive blood cultures, mortality, and missed dialysis treatments were calculated, and incidence-rate ratios (IRRs were estimated using Poisson regression models. Utilization of erythropoiesis-stimulating agents (ESAs and thrombolytics was described for each patient-month and compared using mixed linear models. Models were run without adjustment, adjusted for covariates that were imbalanced between cohorts, or fully adjusted for all potential confounders. Results: The analysis comprised 10,652 Tego patients and 6,493 controls. Tego use was independently associated with decreased risk of CRBSI, defined by initiation of IV antibiotics (adjusted IRR 0.92, 95% confidence interval [CI] 0.87–0.97 or initiation of IV antibiotic course (adjusted IRR 0.89, 95% CI 0.84–0.95. Tego use was independently associated with decreased rate of missed dialysis treatments (adjusted IRR 0.98, 95% CI 0.97–1.00; no significant difference between Tego and control cohorts was observed with respect to mortality. Tego use was associated with decreased likelihood of thrombolytic use (adjusted per

  10. Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study.

    Science.gov (United States)

    Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M; Ravel, Vanessa; Amin, Alpesh N; Cupisti, Adamasco; Chen, Jing; Mathew, Anna T; Kovesdy, Csaba P; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

    2016-08-01

    Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. A longitudinal cohort. 23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year. Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time. Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year. Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m(2)) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m(2); HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d. Potential selection bias and wide CIs. Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality

  11. Non-imaging assisted insertion of un-cuffed, non-tunneled internal jugular venous catheters for hemodialysis: Safety and utility in modern day world

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    Manish Rathi

    2016-08-01

    Full Text Available Background: Absolute necessity in acute kidney injury (AKI and ignorance in chronic kidney disease (CKD make the use of un-cuffed, non-tunneled catheters an indispensable vascular access for hemodialysis. Although these catheters should be inserted under radiological guidance, it may not be feasible in certain circumstances. The aim of the present study was to evaluate safety and outcome of non-imaging assisted insertion of these catheters in internal jugular vein (IJV for hemodialysis. Methods: We analyzed 233 attempts of non-imaging assisted un-cuffed, non-tunneled IJV catheterization at our center. The immediate insertion complications, duration of use, rate and type of infection and other complications were assessed. Results: Out of the 233 attempts, 223 (213-right, 10-left were successful. The most common indication was AKI (n = 127, 54.5%, followed by CKD (n = 99, 42.5%. Successful catheterization at first attempt was achieved in 78.9%. Insertion complications were noted in 12.8% and included arterial puncture (5.2%, hematoma (3.0% and malposition (2.1%. Amongst 219 catheters followed for 4825 days, the mean duration of use was 22 days. Catheter related infections occurred in 42 patients with an incidence of 8.7 per 1000 catheter days. Bacteraemia was present in 10/36 cases (27.7%, positive catheter tip cultures in 71.4% cases and staphylococcal species were the most common organism. Cumulative hazard analysis by Cox regression revealed a linear increase in the risk for infection with each week. Conclusion: Non-imaging assisted insertion of uncuffed, non-tunneled catheters is associated with slightly higher rate of insertion complication but comparable outcome in terms of infection rate or days of use. Keywords: Hemodialysis, Internal jugular vein catheterization, Catheter related infection

  12. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  13. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

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    Coentrão Luis

    2012-08-01

    Full Text Available Abstract Background Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD over hemodialysis (HD, the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. Methods A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC or a functional arteriovenous fistula (HD-AVF in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42. All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Results Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (pp = 0.017 and cardiovascular disease (p = 0.020. Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069, emergency room visits (ppvs. 0.93 vs. 0.64, per patient-year; pvs. 0.07 vs. 0.14, per patient-year; p = 0.034 than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (pp = 0.024. Conclusion Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

  14. Two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging dialysis catheter.

    Science.gov (United States)

    Yoon, William J; Lorelli, David R

    2015-01-01

    The purpose of this study is to report a novel two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging hemodialysis catheter in internal jugular vein (IJV) catheter-dependent patients with contralateral central venous occlusion. The first stage is to implant the ePTFE component and consists of: 1) performing two to three incisions in the upper arm ipsilateral to the preexisting IJV catheter, 2) tunneling the expanded polytetrafluoroethylene (ePTFE) component through these incision sites, and 3) placing the ePTFE component in the subcutaneous tissue without anastomosing it to the target artery. The preexisting IJV catheter is maintained to provide continuous dialysis access. The second stage is initiated in 4 weeks and includes: 1) thrombectomy and anastomosing the ePTFE component arterial end to the target artery, 2) insertion of the venous outflow component using the preexisting IJV catheter access site, and 3) connecting the venous outflow component to the ePTFE component in the standard fashion. The HeRO graft was successfully implanted in two stages without using a femoral bridging catheter. Immediate postimplant cannulatabilty was achieved upon completion of the second stage procedure. This novel two-stage HeRO implantation technique is simple, yet allows immediate cannulation upon completion of the second stage procedure while avoiding the need of a femoral bridging catheter in IJV catheter- dependent patients with contralateral central venous occlusion, and thus lowering the risk of infection related to a femoral bridging catheter.

  15. Laparoscopic correction of peritoneal catheter dysfunction.

    Science.gov (United States)

    Kazemzadeh, Gholamhossein; Modaghegh, Mohammad-Hadi Saeed; Tavassoli, Alireza

    2008-10-01

    To present our experiences with laparoscopic repair of peritoneal catheter dysfunction Total of 24 patients with peritoneal catheter malfunction were considered for two-port laparoscopic manipulation. Two patients with unsuccessful result in the first trial and 3 patients with successful peritoneal dialysis results were reoperated because of catheter dysfunction. The success rates at the first and second manipulation was 79% and 80%. The most frequent cause of catheters dysfunction was migration of catheters out of the true pelvis. During the follow up, 8 patients were referred for renal transplantation, 8 underwent hemodialysis and 5 continued with normal catheter function. The mean longevity of the catheters after laparoscopic correction was 42 months. One year longevity rate as measured as 79%. Laparoscopy is the procedure of choice even in recurrent cases, for correction of malfunctioning continuous ambulatory peritoneal catheters, because this procedure is the only technique that can detects pathologic causes of catheters malfunction and can resolve those problems at the same time.

  16. Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study

    OpenAIRE

    Clark, Edward G.; Paparello, James J.; Wayne, Diane B.; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E.; Barsuk, Jeffrey H.

    2014-01-01

    Background Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Objectives Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedu...

  17. Comparative effectiveness of 30 % trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters: a randomized controlled trial (CITRIM trial).

    Science.gov (United States)

    Correa Barcellos, Franklin; Pereira Nunes, Bruno; Jorge Valle, Luciana; Lopes, Thiago; Orlando, Bianca; Scherer, Cintia; Nunes, Marcia; Araújo Duarte, Gabriela; Böhlke, Maristela

    2017-04-01

    Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients. Randomized, double-blind controlled trial comparing the event-free survival of non-tunneled CVC locked with heparin or TSC30 % in adult hemodialysis patients. The study included 464 catheters, 233 in heparin group, and 231 in TSC30 % group. The CRBSI-free survival of TSC30 % group was significantly shorter than that of heparin group. When stratified by insertion site, heparin was better than TSC30 % only in subclavian CVC. The dysfunction-free survival was not different between groups in the main analysis, but there is also a shorter survival among subclavian CVC locked with TSC30 % in stratified analysis. There was no difference on CRBSI-free or dysfunction-free survival between jugular vein CVC locked with heparin or 30 % citrate. However, subclavian CVC locked with 30 % citrate presented shorter event-free survival. This difference may be related to anatomical and positional effects, CVC design, and hydraulic aspects of the lock solution. CLINICALTRIALS. NCT02563041.

  18. Avoiding the use of a femoral bridging catheter using a two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique.

    Science.gov (United States)

    Yoon, William J; Lorelli, David R

    2015-01-01

    To evaluate a two-stage Hemodialysis Reliable Outflow (HeRO) implantation technique that avoids the use of a femoral bridging catheter versus the conventional one-stage technique requiring a bridging catheter in selected patients. A retrospective review was performed on 20 end-stage renal disease patients with an internal jugular vein (IJV) catheter selected for two-stage HeRO implantation at our institution between January 2010 and March 2013. The arterial graft component (AGC) was implanted without anastomosing it to the target artery (first stage). After AGC incorporation, the venous outflow component was inserted (second stage). The preexisting IJV catheter was maintained for hemodialysis access during the interstage period. Patient characteristics, patency using Kaplan-Meier method and infection rates were analyzed. A total of 17 patients with a mean age of 59 years (70.6% women) completed the two-stage procedure. During the interstage period (mean 12 weeks, range 4-22 weeks), no graft- or surgery-related infection occurred. The need of a femoral bridging catheter was avoided by utilizing the preexisting IJV dialysis catheter. The accumulated HeRO days were 3,916 days with a mean follow-up of 7.7 months (range 1-22.6 months). The HeRO-related infection rate was 0.3/1,000 days. The primary assisted and secondary patency rates at 6 months were 69% and 82%, respectively, which were similar to those of arteriovenous grafts. Staging conferred immediate vascular accessibility. Avoiding the use of a femoral bridging catheter using the two-stage technique may lower infection rate, with comparable primary assisted and secondary patency to arteriovenous grafts and added benefit of immediate cannulatability in this subset of patients.

  19. Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation.

    Science.gov (United States)

    Yuo, Theodore H; Chaer, Rabih A; Dillavou, Ellen D; Leers, Steven A; Makaroun, Michel S

    2015-12-01

    Current guidelines suggest that arteriovenous fistula (AVF) is associated with survival advantage over arteriovenous graft (AVG). However, AVFs often require months to become functional, increasing tunneled dialysis catheter (TDC) use, which can erode the benefit of an AVF. We sought to compare survival in patients with end-stage renal disease after creation of an AVF or AVG in patients starting hemodialysis (HD) with a TDC and to identify patient populations that may benefit from preferential use of AVG over AVF. Using U.S. Renal Data System databases, we identified incident HD patients in 2005 through 2008 and observed them through 2008. Initial access type and clinical variables including albumin levels were assessed using U.S. Renal Data System data collection forms. Attempts at AVF and AVG creation in patients who started HD through a TDC were identified by Current Procedural Terminology codes. We accounted for the effect of changes in access type by truncating follow-up when an additional AVF or AVG was performed. Survival curves were then constructed, and log-rank tests were used for pairwise survival comparisons, stratified by age. Multivariate analysis was performed with Cox proportional hazards regressions; variables were chosen using stepwise elimination. An interaction of access type and albumin level was detected, and Cox models using differing thresholds for albumin level were constructed. The primary outcome was survival. Among the 138,245 patients who started with a TDC and had complete records amenable for analysis, 22.8% underwent AVF creation (mean age ± standard deviation, 68.9 ± 12.5 years; 27.8% mortality at 1 year) and 7.6% underwent AVG placement (70.2 ± 12.0 years; 28.2% mortality) within 3 months of HD initiation; 69.6% remained with a TDC (63.2 ± 15.4 years; 33.8% mortality). In adjusted Cox proportional hazards regression, AVF creation is equivalent to AVG placement in terms of survival (hazard ratio [HR], 0.98; 95% confidence

  20. Does antimicrobial lock solution reduce catheter-related infections in hemodialysis patients with central venous catheters? A Bayesian network meta-analysis.

    Science.gov (United States)

    Zhang, Jun; Wang, Bo; Li, Rongke; Ge, Long; Chen, Kee-Hsin; Tian, Jinhui

    2017-04-01

    The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial lock solutions (ALS) for prevention of catheter-related infections (CRI) in patients with hemodialysis (HD) and ranking these ALS for practical consideration. We searched six electronic databases, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared ALS for preventing episodes of CRI in patients with HD either head-to-head or against control interventions using non-ALS. Two authors independently assessed the methodological quality of included studies using the Cochrane risk of bias tool and extracted relevant information according to a predesigned extraction form. Data were analysed using the WinBUGS (V.1.4.3) and the Stata (V.13.0). Finally, 18 studies involving 2395 patients and evaluating 9 ALS strategies were included. Network meta-analysis showed that gentamicin plus citrate (OR 0.07, 95% CrI 0.00-0.48) and gentamicin plus heparin (OR 0.04, 95% CrI 0.00-0.23) were statistically superior to heparin alone in terms of reducing CRBSI. For exit site infection and all-cause mortality, no significant difference in the intervention effect (p > 0.05) was detected for all included ALS when compared to heparin. Moreover, all ALS were similar in efficacy (p > 0.05) from each other for CRBSI, exit site infection and all-cause mortality. Our findings indicated that gentamicin plus heparin may be selected for the prophylaxis of CRI in patients undergoing HD with CVCs. Whether this strategy will lead to antimicrobial resistance remains unclear in view of the relatively short duration of included studies. More attentions should be made regarding head-to-head comparisons of the most commonly used ALS in this field.

  1. Dialysis - hemodialysis

    Science.gov (United States)

    Artificial kidneys - hemodialysis; Dialysis; Renal replacement therapy - hemodialysis; End-stage renal disease - hemodialysis; Kidney failure - hemodialysis; Renal failure - hemodialysis; Chronic kidney disease - hemodialysis

  2. Salivary function in patients with chronic renal failure undergoing hemodialysis

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    Kaya, M.; Cermik, T.F.; Uestuen, F.; Sen, S.; Berkarda, S. [Trakya Univ., Edirne (Turkey). Medical Faculty

    2002-04-01

    The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40{+-}13 yr) and 14 healthy control subjects (mean age: 40{+-}13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of {sup 99m}Tc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection , 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (T{sub max}) for the prestimulated period, the time of minimum radioactivity (T{sub min}), as an indicator of velocity of secretion after stimulation, and the Lem E{sub 5}% value as an indicator of the secretion function. When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in T{sub max}, T{sub min} and Lem E{sub 5}% values for bilateral parotid glands, and T{sub min} values for bilateral submandibular glands (p<0.05), there were no statistically significant differences in T{sub max} and Lem E{sub 5}% values for bilateral submandibular glands. There were also significant differences in T{sub max} and Lem E{sub 5}% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). In this study, prolonged T{sub max} and T{sub min} values, and decreased Lem E{sub 5}% values for parotid glands and prolonged T{sub min} values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with

  3. Stimulating catheter as a tool to evaluate peripheral nerve function during hip rotationplasty

    NARCIS (Netherlands)

    Werdehausen, Robert; Braun, Sebastian; Hermanns, Henning; Krauspe, Rüdiger; Lipfert, Peter; Stevens, Markus F.

    2007-01-01

    Objective: Stimulating catheters have been introduced into clinical practice to confirm perineural localization of the catheters. The muscular twitch induced over the catheter may be used to evaluate nerve function intraoperatively. Therefore, the function of the sciatic nerve was evaluated during

  4. Spironolactone in chronic hemodialysis patients improves cardiac function

    Directory of Open Access Journals (Sweden)

    Taheri Shahram

    2009-01-01

    Full Text Available We performed this study to assess whether low dose spironolactone could be admi-nistered in hemodialysis (HD patients with moderate to severe heart failure to improve cardio-vascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chro-nic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spi-ronolactone after each dialysis session within six months, and the rest received a placebo. Echo-cardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased signi-ficantly more in spironolactone group during the study period than in the placebo group (6.2 ± 1.64 vs. 0.83 ± 4.9, P= 0.046. The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 ± 4.72 vs. 3 ± 7.97. 95%, P= 0.021. The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia.

  5. Effect of catheter-lock solutions on catheter-related infection and inflammatory syndrome in hemodialysis patients: heparin versus citrate 46% versus heparin/gentamicin.

    Science.gov (United States)

    Venditto, Marcia; du Montcel, Sophie Tezenas; Robert, Jérôme; Trystam, David; Dighiero, Jean; Hue, Danièle; Bessette, Christelle; Deray, Gilbert; Mercadal, Lucile

    2010-01-01

    Prevention strategies are emerging with the use of catheter-lock solutions (CLS) to prevent catheter-related infections. We compared 3 CLS: heparin, citrate (46%) and heparin/gentamicin (H/G). Three periods of 6 months using the three CLS were compared. 265 catheters were studied. The CRI rate per 1,000 catheter-days was 2.9 for heparin, 3.4 for citrate and 0.4 for H/G. The free-infection catheter survival tended to be higher with H/G (log-rank test, p = 0.06) and the CRP had a significant decreasing course (p = 0.03). Since 2006 H/G was used as CLS in our dialysis unit. The resistance to gentamicin of Enterobacteriaceae increased in the nephrology department and in the entire hospital. On the other hand, the resistance of Staphylococcus aureus to gentamicin dropped to nil. CLS with heparin/gentamicin tended to decrease CRI compared to citrate 46% and heparin and frankly improved the CRP course after catheter insertion. Gentamicin resistance should be monitored.

  6. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed E. Abdalla

    2013-01-01

    Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

  7. A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis.

    Science.gov (United States)

    Aitken, Emma; Thomson, Peter; Bainbridge, Leigh; Kasthuri, Ram; Mohr, Belinda; Kingsmore, David

    2017-03-01

    Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC. The study randomized 121 adult patients requiring urgent vascular access for HD in a 1:1 fashion to receive an ecAVG with or without (+/-) an arteriovenous fistula (AVF; n = 60) or TCVC+/-AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy vascular access for HD. The strategy also proved to be cost-neutral. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  8. Catheter Angiography

    Medline Plus

    Full Text Available ... most cases, the kidneys will regain their normal function within five to seven days. Rarely, the catheter ... limitations of Catheter Angiography? Patients with impaired kidney function, especially those who also have diabetes, are not ...

  9. Patency and complications of translumbar dialysis catheters

    Science.gov (United States)

    Liu, Fanna; Bennett, Stacy; Arrigain, Susana; Schold, Jesse; Heyka, Robert; McLennan, Gordon; Navaneethan, Sankar D.

    2016-01-01

    Background Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short and long-term patency and safety of TLDC. Methods We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter related complications were used to estimate catheter safety. Results There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/min) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter and total catheter were 65, 84 and 244 respectively. The catheter patency rate at 3, 6 and 12 months were 43%, 25% and 7% respectively. The main complications were poor blood flow (40%) and catheter related infection (36%), which led to 30.8% and 35.9% catheter removal respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. Conclusion This study data suggests that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access. PMID:25800550

  10. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  11. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  12. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... most cases, the kidneys will regain their normal function within five to seven days. Rarely, the catheter ...

  13. Development of A MEMS Based Manometric Catheter for Diagnosis of Functional Swallowing Disorders

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, H Y [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Hariz, A J [School of Electrical and Information Engineering, University of South Australia (Australia); Omari, T [Centre for Paediatric and Adolescent Gastroenterology, Women' s and Children' s Hospital, Adelaide (Australia); Teng, M F [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Sii, D [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Chan, S [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Lau, L [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Tan, S [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Lin, G [Centre for Advanced Manufacturing Research, University of South Australia, Adelaide (Australia); Haskard, M [School of Electrical and Information Engineering, University of South Australia (Australia); Mulcahy, D; Bakewell, M [Centre for Paediatric and Adolescent Gastroenterology, Women' s and Children' s Hospital, Adelaide (Australia)

    2006-04-01

    Silicon pressure sensors based on micro-electro-mechanical-systems (MEMS) technologies are gaining popularity for applications in bio-medical devices. In this study, a silicon piezo-resistive pressure sensor die is used in a feasibility study of developing a manometric catheter for functional swallowing disorders diagnosis. The function of a manometric catheter is to measure the peak and intrabolus pressures along the esophageal segment during the swallowing action. Previous manometric catheters used the water perfusion technique to measure the pressure changes. This type of catheter is reusable, large in size and the pressure reading is recorded by an external transducer. Current manometric catheters use a solid state pressure sensor on the catheter itself to measure the pressure changes. This type of catheter reduces the discomfort to the patient but it is reusable and is very expensive. We carried out several studies and experiments on the MEMS-based pressure sensor die, and the results show the MEMS-based pressure sensors have a good stability and a good linearity output response, together with the advantage of low excitation biasing voltage and extremely small size. The MEMS-based sensor is the best device to use in the new generation of manometric catheters. The concept of the new MEMS-based manometric catheter consists of a pressure sensing sensor, supporting ring, the catheter tube and a data connector. Laboratory testing shows that the new calibrated catheter is capable of measuring pressure in the range from 0 to 100mmHg and maintaining stable condition on the zero baseline setting when no pressure is applied. In-vivo tests are carried out to compare the new MEMS based catheter with the current version of catheters used in the hospital.

  14. Hemodialysis treatment of cardiorenal syndrome.

    Science.gov (United States)

    Leskovar, Boštjan; Furlan, Tjaša; Poznič, Simona; Potisek, Maja; Adamlje, Anton

    We evaluated the impact of hemodialysis on mortality and hospital readmission in patients with cardiorenal syndrome. 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. Patients were treated with low-efficacy bicarbonate hemodialysis with permanent central venous catheter used as vascular access. Since 2004, 67 patients were started on hemodialysis because of cardiorenal syndrome. Hospital readmission rate due to heart failure decreased (1 year before dialysis vs. 1 year after dialysis: 0.79 ± 1.32 vs. 0.22 ± 0.65 hospitalizations per year, p = 0.001) together with the duration of annual hospital stay (11.4 ± 21.4 vs. 3.7 ± 10.4 days, p = 0.011). 1-, 2-, 3-, 4- and 5-year survival for our patients was 81%, 61%, 52%, 47%, and 39%, respectively. Chronic renal replacement therapy with hemodialysis and strict uremic, electrolyte, and volume control may be more beneficial for patients with advanced heart failure with preserved or reduced LVEF than ultrafiltration alone. We have observed better survival of terminal cardiorenal patients treated with hemodialysis than in the general NYHA IV population, with lower hospital readmission rate and less hospitalized days for heart failure.
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  15. Long-term effects of arteriovenous fistula closure on echocardiographic functional and structural findings in hemodialysis patients: a prospective study.

    Science.gov (United States)

    Movilli, Ezio; Viola, Battista Fabio; Brunori, Giuliano; Gaggia, Paola; Camerini, Corrado; Zubani, Roberto; Berlinghieri, Nicola; Cancarini, Giovanni

    2010-04-01

    The arteriovenous fistula (AVF) provides an effective vascular access for hemodialysis; however, the associated hemodynamic effects may alter cardiac structure and function. The objective of this study is to evaluate the effect of AVF closure on functional and structural echocardiographic findings. Prospective observational study. In a single center between 2003 and 2006, we enrolled 25 consecutive hemodialysis patients with AVF malfunction who underwent AVF closure and conversion to a tunneled central venous catheter because of exhaustion of alternative vascular sites and 36 matched controls with a well-functioning AVF. AVF closure. Outcomes were changes in findings on echocardiograms obtained before and 6 months after AVF closure for patients in the AVF-closure group and at baseline and 6 months later for controls. Echocardiographic measurements included left ventricular (LV) internal diastolic diameter, interventricular septum thickness, diastolic posterior wall thickness, LV mass (LVM), LVM index (LVMi), and LV ejection fraction (LVEF). Dialysis modality and scheme were unchanged. In the AVF-closure group, LVM decreased from 225 +/- 55 to 206 +/- 51 g (P < 0.001) and LVMi decreased from 135 +/- 40 to 123 +/- 35 g/m(2) (P < 0.001). LV internal diastolic diameter, interventricular septum thickness, and diastolic posterior wall thickness decreased significantly, whereas LVEF increased from 56% +/- 7% to 59% +/- 6% (P < 0.001). No significant changes were observed in controls. In patients with AVF closure, LV morphologic characteristics showed a decrease in both eccentric and concentric hypertrophy in favor of normalization or a pattern of concentric remodeling. No significant changes were observed in controls. Use of matched rather than randomized controls. Closure of an AVF determines a significant decrease in LV internal diastolic diameter, interventricular septum thickness, and diastolic posterior wall thickness. This is associated with significant improvement

  16. Vascular calcification and cardiac function according to residual renal function in patients on hemodialysis with urination.

    Directory of Open Access Journals (Sweden)

    Dong Ho Shin

    Full Text Available Vascular calcification is common and may affect cardiac function in patients with end-stage renal disease (ESRD. However, little is known about the effect of residual renal function on vascular calcification and cardiac function in patients on hemodialysis.This study was conducted between January 2014 and January 2017. One hundred six patients with residual renal function on maintenance hemodialysis for 3 months were recruited. We used residual renal urea clearance (KRU to measure residual renal function. First, abdominal aortic calcification score (AACS and brachial-ankle pulse wave velocity (baPWV were measured in patients on hemodialysis. Second, we performed echocardiography and investigated new cardiovascular events after study enrollment.The median KRU was 0.9 (0.3-2.5 mL/min/1.73m2. AACS (4.0 [1.0-10.0] vs. 3.0 [0.0-8.0], p = 0.05 and baPWV (1836.1 ± 250.4 vs. 1676.8 ± 311.0 cm/s, p = 0.01 were significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than a KRU ≥ 0.9 mL/min/1.73m2. Log-KRU significantly negatively correlated with log-AACS (ß = -0.29, p = 0.002 and baPWV (ß = -0.19, P = 0.05 after factor adjustment. The proportion of left ventricular diastolic dysfunction was significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than with a KRU ≥ 0.9 mL/min/1.73m2 (67.9% vs. 49.1%, p = 0.05. Patients with a KRU < 0.9 mL/min/1.73m2 showed a higher tendency of cumulative cardiovascular events compared to those with a KRU ≥ 0.9 ml/min/1.73m2 (P = 0.08.Residual renal function was significantly associated with vascular calcification and left ventricular diastolic dysfunction in patients on hemodialysis.

  17. Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course.

    Science.gov (United States)

    Neumann, Denise; Mau, Wilfried; Wienke, Andreas; Girndt, Matthias

    2017-10-14

    Impaired cognitive functioning in patients with end-stage renal disease may reduce their capabilities to adhere to complex medical or dietary regimens and to fully participate in medical decisions. With decreasing renal function, cognitive abilities are likely to decline, with cognitive dysfunction improving after initiation of dialysis and even being generally reversible after successful renal transplantation. However, little is known about cognitive changes particularly regarding different treatment modalities. To gain further insight into this, we focused on a one-year course of cognitive functions, comparing peritoneal to hemodialysis patients. Within the CORETH-project, two validated neurocognitive tests, assessing executive functioning (Trail Making Test-B) and attention (d2-Revision-Test) and the self-reported Kidney Disease Quality of Life Short Form Cognitive Function-subscale, were administered to 271 patients at baseline and after one year. Subsamples were matched by propensity score, adjusting for age, comorbidity, education, and employment status for 96 hemodialysis and 101 peritoneal dialysis patients. The effects of time and treatment modality were investigated, controlling for well-known confounders. Both tests revealed improvement over one year. Peritoneal dialysis was associated with better outcomes than hemodialysis at baseline and follow-up, but comparability between groups may be limited. The opposite pattern applied to self-reporting. Hemodialysis patients had to be excluded from cognitive testing more often than peritoneal dialysis patients. As such, the number of exclusions may have biased the findings, limiting generalizability. Thus, our findings suggest an improvement of cognitive functioning and support previous indications for peritoneal dialysis being associated with better cognitive functions during a one-year course than hemodialysis. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights

  18. SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

    Directory of Open Access Journals (Sweden)

    A. Keshvari

    2006-06-01

    Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

  19. No relationship between low-density lipoproteins and endothelial function in hemodialysis patients.

    Science.gov (United States)

    Dalton, Brad S; Fassett, Rob G; Geraghty, Dominic P; De Ryke, Rex; Coombes, Jeff S

    2005-03-18

    Relationships between low-density lipoprotein cholesterol and endothelial function in hemodialysis patients have yet to be investigated. Furthermore, current reporting of endothelial function data using flow-mediated dilatation has recognised limitations. The aims of the study were to determine the relationship between low-density lipoproteins and endothelial function in hemodialysis patients and to investigate the validity of determining the area under the curve for data collected during the flow-mediated dilatation technique. Brachial artery responses to reactive hyperemia (endothelial-dependent) and glyceryl trinitrate (endothelial-independent) were assessed in 19 hemodialysis patients using high-resolution ultrasound. Lipid profiles and other factors known to effect brachial artery reactivity were also measured prior to the flow-mediated dilatation technique. There were no significant relationships between serum low-density lipoproteins and endothelial-dependent or -independent vasodilation using absolute change (mm), relative change (%), time to peak change (s) or area under the curve (mm x s). In hemodialysis patients with atherosclerosis, area under the curve analysis showed a significantly (p<0.05) decreased endothelial-dependent response (mean+/-S.D.: 19.2+/-17.4) compared to non-atherosclerotic patients (42.3+/-28.6). However, when analysing these data using absolute change, relative change or time to peak dilatation, there were no significant differences between the two groups. In summary, there was no relationship between low-density lipoproteins and endothelial function in hemodialysis patients. In addition, area under the curve analysis of flow-mediated vasodilatation data may be a useful method of determining the temporal vascular response during the procedure.

  20. Physical exercise modifies the functional capacity of elderly patients on hemodialysis

    OpenAIRE

    Marchesan, Moane; Krug, Rodrigo de Rosso; Silva,José Raphael Leandro da Costa e; BARBOSA,Aline Rodrigues; Rombaldi, Airton José

    2016-01-01

    Abstract Introduction Patients on hemodialysis (HD) improve functional capacity after physical training. However, little is discussed about these effects in elderly patients, since these are usually excluded of studies, due to their physical disabilities and other deficits. Objective To analyze the effects of aerobic and resistance training in the functional capacity of elderly patients submitted to HD. Methods Studied participants were 15 patients, of both genders, and aged over 60 years...

  1. Significance of residual renal function for phosphate control in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Harin Rhee

    2014-03-01

    Conclusion: In chronic hemodialysis patients, preservation of residual renal function is a significant determinant of phosphate control, and the factors associated with phosphate control is different depending on the residual renal function status. In the anuric patients, FGF-23 is most significantly associated with phosphate control; however, glomerular filtration rate and blood urea nitrogen are more important than FGF-23 in the nonanuric HD patients.

  2. Kidney function and metabolic profile of chronic kidney disease and hemodialysis patients during Ramadan fasting.

    Science.gov (United States)

    Al Wakeel, Jamal S

    2014-07-01

    This study aimed to investigate effects of fasting during the Ramadan month among chronic kidney disease (CKD) and hemodialysis patients. A prospective study was carried out on patients seen between August and November 2010 at two hospitals of King Saud University. Volunteers from among patients with CKD and hemodialysis patients were evaluated for kidney function and complications before, during, and after 14-hour daily Ramadan fasting for 30 days. A modified schedule for medication and dialysis regimen was provided to the participants. Thirty-nine CKD patients (41.0% in stage 3 and 43.6% in stage 4) were included. There were no differences in the laboratory and clinical variables before, during, and after the fasting month. Thirty-two hemodialysis patients with a mean duration of dialysis of 4.4 +/- 3.7 years were also included in the study. There was a significant increase in erythrocyte count, serum creatinine, blood urea, serum phosphorus, serum albumin, and serum uric acid levels during the fasting period. Hyperkalemia developed in 25.0% and 15.6% of the hemodialsysis patients during and after the fasting period and hyponatremia in 15.6% and 28.0%, respectively. Forty-six percent of the patients developed hypertension and 36.7% fluid overload. No adverse events requiring hospital admission were observed. Fourteen-hour fasting for one month was tolerated by CKD and hemodialysis patients, although there were considerable changes among hemodialysis patients in some of the blood chemistry variables. No serious adverse events occurred.

  3. The Effect of Renal Function and Hemodialysis Treatment on Plasma Vasopressin and Copeptin Levels.

    Science.gov (United States)

    Ettema, Esmée M; Heida, Judith; Casteleijn, Niek F; Boesten, Lianne; Westerhuis, Ralf; Gaillard, Carlo A J M; Gansevoort, Ron T; Franssen, Casper F M; Zittema, Debbie

    2017-05-01

    Copeptin is increasingly used in epidemiological studies as a substitute for vasopressin. The effect of renal function per se on copeptin and vasopressin concentrations as well as their ratio have, however, not been well described. Copeptin and vasopressin levels were measured in 127 patients with various stages of chronic kidney disease, including 42 hemodialysis patients and 16 healthy participants in this observational study. Linear (segmental) regression analyses were performed to assess the association between renal function and copeptin, vasopressin and the C/V ratio. In addition, clearance of copeptin and vasopressin by hemodialysis was calculated. Both copeptin and vasopressin levels were higher when renal function was lower, and both showed associations with plasma osmolality. The C/V ratio was stable across renal function in subjects with an eGFR >28 ml/min per 1.73 m2. In contrast, the C/V ratio increased with worsening renal function in patients with eGFR ≤28 ml/min per 1.73 m2. During hemodialysis, the initial decrease in vasopressin levels was greater compared with copeptin and, consequently, the C/V ratio increased. This was, at least in part, explained by a greater dialytic clearance of vasopressin compared with copeptin. Our data indicate that copeptin is a reliable substitute for vasopressin in subjects with an eGFR >28 ml/min per 1.73 m2, whereas at an eGFR ≤28 ml/min per 1.73 m2, that is, CKD stages 4 and 5, a correction for renal function is required in epidemiological studies that use copeptin as a marker for vasopressin. Intradialytic copeptin levels do not adequately reflect vasopressin levels because vasopressin clearance by hemodialysis is higher than that of copeptin.

  4. Stimulating catheter as a tool to evaluate peripheral nerve function during hip rotationplasty.

    Science.gov (United States)

    Werdehausen, Robert; Braun, Sebastian; Hermanns, Henning; Krauspe, Rüdiger; Lipfert, Peter; Stevens, Markus F

    2007-01-01

    Stimulating catheters have been introduced into clinical practice to confirm perineural localization of the catheters. The muscular twitch induced over the catheter may be used to evaluate nerve function intraoperatively. Therefore, the function of the sciatic nerve was evaluated during major cancer surgery of the femur. A 7-year-old boy (29 kg) was scheduled for hip rotationplasty for resection of an osteosarcoma of the left femur under general anesthesia and postoperative pain therapy with an epidural stimulating catheter. In hip rotationplasty the femur is resected, the lower limb and foot are rotated 180 degrees and the tibia plateau is attached to the pelvic acetabulum to form a new hip joint. During preparation of the left thigh and the sciatic nerve, motor responses to stimulation of the catheter were preserved, but the stimulation threshold increased. After vascular anastomosis the foot remained cold, therefore ropivacaine was applied epidurally and subsequently a warming of the foot was observed. At the end of the operation, the patient was free of pain, a good capillary pulse of the leg was observed, and the patient was able to move the foot and toes of the rotated leg. The use of epidural stimulating catheters as a tool to monitor nerve function is a novel and simple procedure to monitor nerve function intraoperatively and to enable good postoperative pain control.

  5. Effect of hs-CRP level and nutritional status on pulmonary function in patients with maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Ru Lei

    2016-04-01

    Full Text Available Objective: To explore the effect of hs-CRP level and nutritional status on the pulmonary function in patients with maintenance hemodialysis (MHD. Methods: A total of 30 patients with chronic renal failure (CRF who were admitted in our hospital from August, 2014 to August, 2015 for hemodialysis were included in the study. A volume of 4mL morning fasting elbow venous blood before and after hemodialysis was extracted, and was then centrifuged for serum. The levels of Hb, Alb, and PA were detected. VC, FVC, FEV1, FEV1/ FVC, PEF, and MMEF were determined. Results: The levels of Hb, Alb, and PA after hemodialysis were significantly higher than those before hemodialysis (P<0.05. VC, FVC, FEV1, FEV1/FVC, PEF, and MMEF after hemodialysis were significantly improved when compared with before treatment (P<0.05. The comparison of VC, FVC, FEV1, FEV1/FVC, PEF, and MMEF among patients with different levels of hs-CRP was statistically significant (P<0.05. Conclusions: The reduction of pulmonary function in different degrees exists in MHD patients. MHD is kind of effective method to improve the pulmonary function in patients with CRF. The effective improvement of nutritional status and the reduction of in vivo inflammatory reaction in patients with CRF in the clinic can relieve the deterioration of pulmonary function to a certain degree so that to improve the ventilation function and enhance the living quality.

  6. Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

    Science.gov (United States)

    Clark, Edward G; Paparello, James J; Wayne, Diane B; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E; Barsuk, Jeffrey H

    2014-01-01

    Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Pre-test - post-test study. 2014 Canadian Society of Nephrology annual meeting. Nephrology fellows, internal medicine residents and medical students. Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Small sample-size and

  7. Quality of life development during initial hemodialysis therapy and association with loss of residual renal function

    DEFF Research Database (Denmark)

    Poulsen, Christina G; Kjaergaard, Krista D; Peters, Christian D

    2017-01-01

    INTRODUCTION: Health related quality of life (HRQOL) is markedly reduced in hemodialysis patients compared to the general population. We investigated the course of self-reported HRQOL over time and the association with selected factors, focusing on changes in glomerular filtration rate (GFR......). METHODS: Eighty-two newly started hemodialysis patients from the SAFIR cohort filled out the Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SFTM ) questionnaire at baseline, 6 and 12 months. The SAFIR study was a randomized, placebo-controlled, double-blind intervention study, examining......, especially diabetes, hospital admissions, female gender, and age were strongly associated with lower HRQOL in cross sectional analysis. DISCUSSION: Preservation of residual renal function seems to be important for HRQOL. In newly started HD patients, HRQOL showed little change after 12 months. HRQOL...

  8. Development of a catheter functionalized by a polydopamine peptide coating with antimicrobial and antibiofilm properties.

    Science.gov (United States)

    Lim, Kaiyang; Chua, Ray Rong Yuan; Bow, Ho; Tambyah, Paul Anantharajah; Hadinoto, Kunn; Leong, Susanna Su Jan

    2015-03-01

    Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infections worldwide, aggravating the problem of antimicrobial resistance and patient morbidity. There is a need for a potent and robust antimicrobial coating for catheters to prevent these infections. An ideal coating agent should possess high antimicrobial efficacy and be easily and economically conjugated to the catheter surface. In this study, we report a simple yet effective immobilization strategy to tether a potent synthetic antimicrobial peptide, CWR11, onto catheter-relevant surfaces. Polydopamine (PD) was deposited as a thin adherent film onto a polydimethylsiloxane (PDMS) surface to facilitate attachment of CWR11 onto the PD-functionalized polymer. Surface characterization of the CWR11-tethered surfaces confirmed the successful immobilization of peptides onto the PD-coated PDMS. The CWR11-immobilized PDMS slides displayed excellent antimicrobial (significant inhibition of 5×10(4) colony-forming units of CAUTI-relevant microbes) and antibiofilm (∼92% enhanced antibacterial adherence) properties. To assess its clinical relevance, the PD-based immobilization platform was translated onto commercial silicone-coated Foley catheters. The CWR11-impregnated catheter displayed potent bactericidal properties against both Gram-positive and Gram-negative bacteria, and retained its antimicrobial functionality for at least 21days, showing negligible cytotoxicity against human erythrocyte and uroepithelial cells. The outcome of this study demonstrates the proof-of-concept potential of a polydopamine-CWR11-functionalized catheter to combat CAUTIs. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  9. Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello [IRCCS Policlinico San Matteo Foundation, Pavia (Italy)

    2014-06-15

    Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

  10. Vascular access conversion and patient outcome after hemodialysis initiation with a nonfunctional arteriovenous access: a prospective registry-based study.

    Science.gov (United States)

    Alencar de Pinho, Natalia; Coscas, Raphael; Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A; Stengel, Bénédicte

    2017-02-22

    Little is known about vascular access conversion and outcomes for patients starting hemodialysis with nonfunctional arteriovenous (AV) access. We assessed mortality risk associated with nonfunctional AV access at hemodialysis initiation, taking subsequent changes in vascular access into account. We studied the 53,092 incident adult hemodialysis patients included in the French REIN registry from 2005 through 2012. AV access placed predialysis was considered nonfunctional when dialysis began with a central venous catheter. Information about vascular access changes was obtained from treatment modality updates. At hemodialysis initiation, AV access was functional for 47% of patients and nonfunctional for 9%; 44% had a catheter alone. After a 3-year follow-up, 63% of patients beginning hemodialysis with a nonfunctional AV access had changed to a functional one, 4% had had a transplant, 19% had died before any vascular access change, and 13% still used a catheter. Cox proportional hazard models with vascular access treated as a time-dependent variable showed an adjusted mortality hazard ratio (95% confidence interval) for patients with nonfunctional AV access who subsequently converted to functional access of 0.95 (95% CI 0.89-1.03) compared with the reference group with functional AV access since first hemodialysis, versus 1.43 (95% CI 1.31-1.55) for those who did not convert. Among patients starting hemodialysis with a nonfunctional AV access, a substantial percentage may never experience successful vascular access conversion. Poor survival seems to be limited to these patients, while those who subsequently convert to functional AV access have similar mortality risk compared to patients with such access since hemodialysis initiation. Every effort should be made to obtain functional AV access in all suitable patients.

  11. Cardiovascular disease and cognitive function in maintenance hemodialysis patients

    Science.gov (United States)

    Cardiovascular disease (CVD) and cognitive impairment are common in dialysis patients. Given the proposed role of microvascular disease on cognitive function, particularly cognitive domains that incorporate executive functions, we hypothesized that prevalent systemic CVD would be associated with wor...

  12. Dilemma with the route of venous access for hemodialysis catheter insertion in a patient with dilated ischemic cardiomyopathy treated by cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Devanahalli Ashokananda

    2016-01-01

    Full Text Available A 68 year old patient requiring urgent dialysis due to raising potassium was referred to our center. He had 3 indwelling catheters in his heart via right subclavian vein. His left subclavian and interngal jugular veins were thrombosed possibly due to earlier indwelling catheters. The dilemma was if right internal jugular venous route could be used for insertion of dialysis catheter. Under fluoroscopic guidance, right internal jugular vein was cannulated with the dialysis catheter without problems. This case is being presented to highlight the need for imaging both by ultrasound and radiography during the procedure.

  13. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... injured due to the contrast material. In most cases, the kidneys will regain their normal function within ...

  14. Catheter Angiography

    Medline Plus

    Full Text Available ... a feeling of warmth or a slight burning sensation. The most difficult part of the procedure may ... the kidneys will regain their normal function within five to seven days. Rarely, the catheter punctures the ...

  15. A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Ashima Sharma

    Full Text Available ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients’ average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94% and hypoalbuminemia (72% were common. Diabetes mellitus (68%, hypertension (34% and coronary artery disease (18% were major comorbidities. Forty-five patients (90% had been on hemodialysis for six months to three years. The patients’ pre-dialysis mean forced vital capacity (FVC and forced expiratory volume in 1 second (FEV1 were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P 0.05. The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05. The mean peak expiratory flow was below normal (43.8 ± 30.7% and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05. Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

  16. The Effect of Renal Function and Hemodialysis Treatment on Plasma Vasopressin and Copeptin Levels

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    Esmée M. Ettema

    2017-05-01

    Discussion: Our data indicate that copeptin is a reliable substitute for vasopressin in subjects with an eGFR >28 ml/min per 1.73 m2, whereas at an eGFR ≤28 ml/min per 1.73 m2, that is, CKD stages 4 and 5, a correction for renal function is required in epidemiological studies that use copeptin as a marker for vasopressin. Intradialytic copeptin levels do not adequately reflect vasopressin levels because vasopressin clearance by hemodialysis is higher than that of copeptin.

  17. Effect of hemodialysis on pulmonary function tests and plasma endothelin levels

    OpenAIRE

    Javid Safa; Hamid Noshad; Khalil Ansarin; Alireza Nikzad; Parviz Saleh; Abdolmohammad Ranjbar

    2014-01-01

    End-stage renal disease (ESRD) is a complex illness that involves different organs including the lungs. We studied the pulmonary function tests, arterial blood gases (ABG) and plasma endothelin-1 (ET-1) levels to check whether there is any change in their levels after hemodialysis (HD) in patients with ESRD. In this cross-sectional study (from July 2009 to April 2010), 20 patients with ESRD were evaluated. ABG, spirometric parameters and plasma ET-1 were measured before and after HD in these ...

  18. Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark [Kosin Medical College, Pusan (Korea, Republic of)

    1997-11-01

    To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.

  19. Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis.

    Science.gov (United States)

    Roxo, Renata Spósito; Xavier, Vivian Bertoni; Miorin, Luiz Antônio; Magalhães, Andrea Olivares; Sens, Yvoty Alves Dos Santos; Alves, Vera Lúcia Dos Santos

    2016-01-01

    Literature shows that patients undergoing hemodialysis present poor physical conditioning and low tolerance to exercise. They may also suffer from respiratory dysfunctions. The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation on pulmonary function and functional capacity of patients with chronic kidney disease on hemodialysis. Forty adult patients with chronic kidney disease on hemodialysis were prospectively studied and randomized into two groups (control n = 20 and treatment n = 20). The treatment group underwent bilateral femoral quadriceps muscles electrical stimulation for 30 minutes during hemodialysis, three times per week, for two months. The patients were evaluated by pulmonary function test, maximum respiratory pressures, maximum one-repetition test, and six-minute walk test (6MWT), before and after the treatment protocol. The treatment group presented increased maximum inspiratory (MIP) (p = 0.02) and expiratory pressures (MEP) (p espirometria, pressões respiratórias máximas, teste de uma repetição máxima e teste da caminhada dos seis minutos (TC6), antes e após o período de acompanhamento. O grupo tratamento apresentou aumento da pressão inspiratória máxima com p = 0,02 na comparação entre grupos e p < 0,001 para a pressão máxima expiratória. O teste de uma repetição máxima e a distância percorrida no TC6 apresentaram-se maiores após o protocolo no grupo de tratamento com p < 0,001 e 0,03 respectivamente. Houve diminuição da pressão arterial sistólica (p < 0,001) e frequência respiratória (p < 0,001) após a estimulação elétrica quando comparado ao grupo controle. A estimulação elétrica neuromuscular teve impacto positivo sobre a função pulmonar e a capacidade funcional levando ao melhor desempenho físico em pacientes em hemodiálise.

  20. The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational, cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Valeria Saglimbene

    Full Text Available Sexual dysfunction may affect 80% of women in hemodialysis. However the specific patterns and clinical correlates of sexual functioning remain poorly described. The aim of this study was to assess prevalence and correlates of the individual domains of sexual functioning in women treated with hemodialysis. We recruited, into this multinational cross-sectional study, women treated with long-term hemodialysis (Collaborative Working Group on Depression and Sexual dysfunction in Hemodialysis study. Self-reported domains of sexual functioning were assessed by the Female Sexual Function Index, which is routinely administered within the network of dialysis patients followed by the working group. Lower scores represented lower sexual functioning. Socio-demographic and clinical correlates of each domain of sexual functioning were identified by stepwise multivariable linear regression. Sensitivity analyses were restricted to women who reported being sexually active. We found that of 1309 enrolled women, 659 (50.3% provided complete responses to FSFI survey questions and 232 (35% reported being sexually active. Overall, most respondents reported either no sexual activity or low sexual functioning in all measured domains (orgasm 75.1%; arousal 64.0%; lubrication 63.3%; pain 60.7%; satisfaction 60.1%; sexual desire 58.0%. Respondents who were waitlisted for a kidney transplant reported scores with higher sexual functioning, while older respondents reported scores with lower functioning. The presence of depression was associated with worse lubrication and pain scores [mean difference for depressed versus non-depressed women (95% CI -0.42 (-0.73 to -0.11, -0.53 (-0.89 to -0.16, respectively] while women who had experienced a previous cardiovascular event reported higher pain scores [-0.77 (-1.40- to -0.13]. In conclusion, women in hemodialysis reported scores consistent with marked low sexual functioning across a range of domains; the low functioning appeared

  1. Morphologic and functional assessment of hemodialysis arteriovenous fistula with duplex doppler sonography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, On Koo; Kim, Yong Soo; Rhim, Hyun Chul; Koh, Byung Hee; Kim, Bong Soo; Song, Soon Young; Park, Chan Hyun [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2001-03-15

    The pattern of morphologic and functional status of the hemodialysis AV fistula was studied using doppler ultrasound to define the useful parameter and its normal range for detecting the initial dysfunctional. Sixty patients of chronic renal failure with radial artery-cephalic vein fistula for hemodialysis (50 clinically normal and 10 clinically abnormal functioning AV fistula) were studied by duplex ultrasound. The examination followed the feeding artery to the draining vein and observed the morphology and waveform of the vessels. Peak systolic velocity (PSV), End diastolic velocity (EDV) and Systolic/Diastolic ratio (S/D ratio) were measured in the feeding artery. In the draining vein, peak velocity was measured and the presence of arterial pulsation was observed. Normal range of these measuring parameters and its significance and reliability for detecting dysfunction AV fistula were studied. In normally functioning fistula, waveforms of flow in the feeding artery were monophasic, with PSV 0.5-3.48 m/sec (average 1.75 {+-} 0.79 m/sec), EDV 0.2-1.47 m/sec (average 0.82 {+-} 0.41 m/sec) and S/D ratio 1.44-3.48 (average 2.34 {+-} 0.56). The draining vein showed components of arterial pulsations with peak velocity of 0.21-1.20 m/sec (average 0.54 {+-} 0.23 m/sec). Of the 10 clinically dysfunctional AV fistula, two cases had arteriosclerous vessel wall calcification and showed normal function on doppler sonography. Two cases of focal stenotic lesion of the draining vein showed significantly increased PSV which were more than 4.0 m/sec. Six cases of venous thrombosis showed a high resistance pattern of reversed diastolic flow with a measured S/D ratio of more than 4.0 and the absence of flow was noted within the draining S/D ratio was statically very reliable parameter (P=0.003) for defining normal and abnormal functioning AV fistula, however PSV and EDVV were unreliable (P=0.459). Duplex ultrasound is a useful diagnostic method for interpretating function of the

  2. Catheter Angiography

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a catheter, x-ray imaging ... the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical test that ...

  3. Family functioning, marital satisfaction and social support in hemodialysis patients and their spouses.

    Science.gov (United States)

    Jiang, Hong; Wang, Li; Zhang, Qian; Liu, De-xiang; Ding, Juan; Lei, Zhen; Lu, Qian; Pan, Fang

    2015-04-01

    A growing number of studies have demonstrated the importance of marital quality among patients undergoing medical procedures. The aim of the study was to expand the literature by examining the relationships between stress, social support and family and marriage life among hemodialysis patients. A total of 114 participants, including 38 patients and their spouses and 38 healthy controls, completed a survey package assessing social support, stress, family functioning and marital satisfaction and quality. We found that hemodialysis patients and spouses were less flexible in family adaptability compared with the healthy controls. Patients and spouses had more stress and instrumental social support compared with healthy people. Stress was negatively associated with marital satisfaction. Instrumental support was not associated with family or marital outcomes. The association between marital quality and support outside of family was positive in healthy individuals but was negative in patients and their spouses. Family adaptability was positively associated with support within family as perceived by patients and positively associated with emotional support as perceived by spouses. In conclusion, findings suggest that social support may promote adjustment depending on the source and type. Future research should pay more attention to the types and sources of social support in studying married couples. Copyright © 2014 John Wiley & Sons, Ltd.

  4. The stuck catheter: a hazardous twist to the meaning of permanent catheters.

    Science.gov (United States)

    Vellanki, Venkat Sainaresh; Watson, Diane; Rajan, Dheeraj K; Bhola, Cynthia B; Lok, Charmaine E

    2015-01-01

    Permanent central venous catheter use is associated with significant complications that often require their timely removal. An uncommon complication is resistant removal of the catheter due to adherence of the catheter to the vessel wall. This occasionally mandates invasive interventions for removal. The aim of this study is to describe the occurrence of this "stuck catheter" phenomenon and its consequences. A retrospective review of all the removed tunneled hemodialysis catheters from July 2005 to December 2014 at a single academic-based hemodialysis center to determine the incidence of stuck catheters. Data were retrieved from a prospectively maintained computerized vascular access database and verified manually against patient charts. In our retrospective review of tunneled hemodialysis catheters spanning close to a decade, we found that 19 (0.92%) of catheters were retained, requiring endovascular intervention or open sternotomy. Of these, three could not be removed, with one patient succumbing to catheter-related infection. Longer catheter vintage appeared to be associated with 'stuck catheter'. Retention of tunneled central venous catheters is a rare but important complication of prolonged tunneled catheter use that nephrologists should be aware of. Endoluminal balloon dilatation procedures are the initial approach, but surgical intervention may be necessary.

  5. Impact of arteriosclerosis on the functioning of arteriovenous fistula for hemodialysis

    Directory of Open Access Journals (Sweden)

    Stolić Radojica

    2007-01-01

    Full Text Available Background/Aim. Numerous clinical studies have shown that the incidence of artheriosclerosis is higher in patients with progressive renal insufficiency. The aim of this study was to examine the incidence of artheriosclerosis in patients on chronic hemodialysis and its influence on survival and functioning of vascular access. Methods. The study was organized as one-year prospective study. All the patients had arteriovenous fistulas native as a vascular access. The study analyzed demographic, biochemical, clinical and Doppler echomorphological characteristics of the patients in order to make an evidence of artheriosclerotic incidences as compared to functioning arteriovenous fistulas for hemodialysis. Results. The examined patients were of the mean age 55.7±12.68 years. Of them, 53.8% were males and 46.2% females. Functioning arteriovenous fistulas for haemodialysis were found in 56.8% of the examined patients. Concentration of hemoglobin was a significant parameter of functioning fistula (group with complications - 89±14.034 vs. group with no complications - 96.6±17.71; p = 0.0489. An amount of urea removed (URR was a statistically more significant parameter among the patients without fistula complications: (group with complications - 58.67±7.92% vs. group with no complications - 62.80±7.53%; p = 0.037. A Cox regressive analysis of an index of Doppler parameters of the carotid arteries found no statistical significance between the examined groups. There was a positive correlation between artheriosclerosis and the age, as well as the time on dialysis. In multiple regression, where intima media is a dependent and the age and time on dialysis independent variables, the regressive model was statistically significant (F = 8.22, p = 0.001. Both independent variables had statistically significant inclinations, p < 0.01. Conclusion. Anemia and the level of urea elimination, as a statistically significant indicator of hemodialysis adequacy, were in

  6. Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Vida Shafipour

    2017-04-01

    Full Text Available Background: hemodialysis patients suffer from impaired functional ability. Several pilot studies have been conducted concerning the effect of home-based exercise on functional ability of hemodialysis patients; however, there have been observed some contradictions between the results of these studies. The aim of this study was, therefore, to determine the effects of home-based exercise on functional ability of hemodialysis patients using meta-analysis. Methods: In this review study, for the purpose of finding studies published electronically form 2000 to 2016, the papers published in journals indexed in the databases of “PubMed, Science Direct, Google Scholar Cochrane” were used. Also, to analyze the full text of these articles, Stata Software Version 11 was used. Heterogeneity index between the studies was determined using Cochran (Q c and I2 tests. Since heterogeneity was observed between the studies, a random effect model was used to estimate the mean score of the standardized difference of a 6-minute walk test in order to measure the functional ability of hemodialysis patients in two experimental and comparison groups. Results: Four articles were finally selected in this meta-analysis. 68 patients were in the experimental group and 65 were in the control group. After the intervention, the mean score of the standardized difference of a 6-minute walk test in the experimental group with a confidence interval of 95% was 0.21 (-0.15, 0.57 units more than before the intervention, which was statistically not significant. Conclusion: The results of the meta-analysis showed that home-based exercise increased the functional ability of hemodialysis patients although this effect was not significant.

  7. Previous hemodialysis access improves functional outcomes of the proximal radial artery fistula in males.

    Science.gov (United States)

    Amendola, Michael F; Pfeifer, John; Albuquerque, Francisco; Wolfe, Luke; Levy, Mark M; Davis, Ronald K

    2015-07-01

    The proximal radial artery fistula (PRA) has been established as an early viable surgical option for arteriovenous fistula creation. The overall assisted primary patency reported in the literature approaches 100% at 1 year. We hypothesize that this excellent patency does not represent a functional result when seen in light of successful cannulation and fistula utilization. We retrospectively queried our Veterans Administration Hospital operative database to identify 284 male patients who had 571 access procedures performed by a senior vascular surgeon attending (R.K.D.) from January 1, 2003, to December 31, 2008. Operative details, patient comorbidities, fistula maturation time (time to first cannulation), functional patency (date of access to abandonment, revision to another fistula type, conversion to a prosthetic graft, thrombosis of the fistula, conversion to peritoneal dialysis, renal transplant, or patient death), and total duration (creation of the fistula to the end of its functional patency) were collected and analyzed. A total of 144 PRAs were placed during the study period. In all, 87 patients underwent primary proximal radial artery fistula (P-PRA) placement in a limb without previous access; 57 patients had a secondary proximal radial artery fistula (S-PRA) after a failed previous fistula or graft in the same limb. There were no differences between the 2 groups in terms of age, comorbidities, and operative details. A total of 91 patients (63.2%) were receiving hemodialysis at the time of P-PRA or S-PRA placement. Outcomes of P-PRA and S-PRA populations on hemodialysis were examined. There was increased cannulation success (33% vs. 55%; P = 0.00354, Fisher's exact test), functional patency (755.2 ± 661.2 days vs. 405.4 ± 531.9 days; P = 0.0220, Wilcoxon two-sample test), and total duration (859.5 ± 650.7 days vs. 516.8 ± 547.2 days; P = 0.0361, Wilcoxon two-sample test) of S-PRA over P-PRA. There was no difference in endovascular interventions

  8. The presence and impact of diastolic dysfunction on physical function and body composition in hemodialysis patients.

    Science.gov (United States)

    Jeong, Jin Hee; Wu, Pei-Tzu; Kistler, Brandon Michael; Fitschen, Peter John; Biruete, Annabel Guzman; Phillips, Shane Aaron; Ali, Mohamed M; Fernhall, Bo; Wilund, Kenneth Robert

    2015-12-01

    Cardiovascular (CV) diseases are the main cause of death in maintenance hemodialysis (MHD) patients. Muscle wasting and physical function decline are common in MHD patients, and significantly impair their quality of life. These can result from abnormalities in cardiac function, which can be further worsened by physical deconditioning. Left ventricular diastolic function parameters were recently shown to be a better predictor of exercise capacity than systolic measures in patients with CV complications. But little is known about the relationship between cardiac function and physical function in MHD patients. In 82 MHD patients, left ventricular systolic dysfunction (LVSD) was assessed by ejection fraction and fractional shortening with echocardiography, and left ventricular diastolic dysfunction (LVDD) was assessed by pulse wave and tissue Doppler indices. Physical function was assessed by gait speed, performance on a shuttle walk test, and leg muscle strength. Dual-emission X-ray absorptiometry (DXA) was used to measure whole body lean mass (WBLM). The prevalence of LVDD and LVSD was 48.8 and 12.2%, respectively. Gait speed, shuttle walk time, leg strength, and WBLM% were significantly higher in the group without LVDD than with LVDD (p physical function or body composition between patients with and without LVSD. These data suggest that LVDD is more closely related to physical function and body composition than LVSD in MHD patients, and hence that LVDD may be an important therapeutic target.

  9. Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients.

    Science.gov (United States)

    Wu, Pei-Tzu; Fitschen, Peter J; Kistler, Brandon M; Jeong, Jin Hee; Chung, Hae Ryong; Aviram, Michael; Phillips, Shane A; Fernhall, Bo; Wilund, Kenneth R

    2015-09-01

    The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.

  10. FUNCTIONAL STATUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE BEING TREATED WITH HEMODIALYSIS IN PKU MUHAMMADIYAH HOSPITAL, YOGYAKARTA, INDONESIA

    Directory of Open Access Journals (Sweden)

    Adiyati Mardiyah

    2017-08-01

    Full Text Available Background: Hemodialysis process is useful for patients with end-stage renal disease. However, this is a situation of abject dependence on a machine, a procedure and a group of qualified medical professionals for the rest of their lives that may influence their functional status. Objective: This study aims to describe the functional status of patients with chronic kidney disease undergoing hemodialysis. Method: This was a descriptive study with cross-sectional design, which conducted in the PKU Muhammadiyah Hospital Yogyakarta on March 2017. There were 78 patients selected using purposive sampling. Functional status was measured using SF-36 questionnaire. Descriptive statistic was performed for data analysis Result:. The total average of functional status level was 42.92, with Physical Component Scale (PCS of 42.31 and Mental Component Scale (MCS of 45.78. Conclusion: There were functional deficiencies in both physical and mental status in patients with CKD undergoing hemodialysis. Thus, it is suggested that pharmacological management of these patients need stringent monitoring on part of the psychiatrist to deal with mental health problems, and the interdisciplinary team need to do great efforts to improve functional status and quality of life of patients with CKD.

  11. Changes in physical functional performance and quality of life in hemodialysis patients in Taiwan: a preliminary study.

    Science.gov (United States)

    Hsieh, Ru-Lan; Huang, Hsiao-Yuan; Chen, Shih-Ching; Lin, Wen-Hsuan; Wu, Chia-Wei; Chang, Chung-Hsin; Lee, Wen-Chung

    2010-01-01

    To study the long-term changes in physical functional performance and quality of life in hemodialysis patients living in the community in Taiwan. This prospective study monitored 27 ambulatory hemodialysis patients for 16 months living in the community in Taiwan. Physical capacity (6-minute walk test, grip strength, pinch strength and chair-rising time), maximal cardiovascular fitness test, functional performance (Functional Independence Measure) and quality of life (WHOQOL-BREF) were evaluated. There were 17 men and 7 women, with a mean age of 61.3 (+/- 9.0) years. The results showed significantly decreased pinch strength (right hand: from 6.4 kg to 4.5 kg, p=0.009; left hand: from 5.6 kg to 4.7 kg, p=0.017) and decreased quality of life (from 89.5 to 85.3 for WHOQOL-BREF total score, p=0.026), especially in the domain of physical health and subcategories of concentrating ability, satisfaction with working ability and sex life, and "eating foods whenever wanted," over the 16-month period. Maximal cardiovascular fitness and functional performance remained stationary during the 16-month period. Significantly declined pinch strength and quality of life, with maintained maximal cardiovascular fitness and functional performance, were noted in ambulatory hemodialysis patients over the 16-month period of follow-up. An intensive pinch strengthening program and overall improvement in quality of life for these patients is needed.

  12. Catheter Angiography

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    Full Text Available ... reopen the vessel. If you have diabetes or kidney disease, the kidneys may be injured due to the contrast material. ... the limitations of Catheter Angiography? Patients with impaired kidney function, especially those who also ... be used for any purpose other than this referral.

  13. Acute Effects of Hemodialysis on Left and Right Ventricular Function: A Doppler Tissue Imaging Study

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    Tansel Erol

    2012-08-01

    Full Text Available Purpose: Doppler tissue imaging (DTI allows noninvasive assessment of both left ventricular (LV and right ventricular (RV function. The aim of this study was to evaluate the effect of hemodialysis (HD on LV and RV function using DTI. Method: Our study group included 30 patients on chronic HD program (mean age 45 15 years. Myocardial (Sm, Em, Am and annular velocities (Ea, Aa were measured in several cardiac territories before and after HD. Results: After HD, Ea significantly reduced from 10.8 3.4 cm/s to 9.6 2.4 cm/s (p = 0.029. Patients exhibited a lower Em following HD in all measured territories. Em/Am ratio was also reduced for each LV wall investigated after HD in all measured territories. At the RV segments, Sm, Em, and Am decreased significantly in all measured territories. Em of the anterior wall was positively related to ultrafiltration volume (r = 0.25, p = 0.006, whereas the decrease of Sm of RV basal segment correlated with a decrease of diastolic blood pressure (r = 0.23, p < 0.01. Conclusion: Our data indicate that a single HD session is associated with acute changes of systolic and diastolic parameters of LV and RV. [Cukurova Med J 2012; 37(4.000: 215-222

  14. Effect of hemodialysis on pulmonary function tests and plasma endothelin levels.

    Science.gov (United States)

    Safa, Javid; Noshad, Hamid; Ansarin, Khalil; Nikzad, Alireza; Saleh, Parviz; Ranjbar, Abdolmohammad

    2014-07-01

    End-stage renal disease (ESRD) is a complex illness that involves different organs including the lungs. We studied the pulmonary function tests, arterial blood gases (ABG) and plasma endothelin-1 (ET-1) levels to check whether there is any change in their levels after hemodialysis (HD) in patients with ESRD. In this cross-sectional study (from July 2009 to April 2010), 20 patients with ESRD were evaluated. ABG, spirometric parameters and plasma ET-1 were measured before and after HD in these patients. Student's t-test was performed to clarify the differences and Pearson's test was used for correlations. P forced expiratory volume (FEV1)/forced vital capacity (FVC) after HD. Plasma ET-1 levels decreased significantly after HD. Mean ET-1 before HD was 6.88 + 5.81 pg/mL while it was 3.91 + 2.76 pg/mL after HD (P = 0.009). Based on the plasma levels of ET-1, the patients were divided into two groups. The mean level of ET-1 was higher in the first group. Significant increase was seen in spirometric parameters in the second group. Our study suggests that, in patients with ESRD, plasma ET-1 level is higher than in the normal population, and this is closely related to deterioration of pulmonary function tests. Significant reduction of plasma ET-1 may be an important factor in the improvement of spiro-metry parameters after HD.

  15. Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

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    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2009-02-15

    Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.

  16. Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure

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    Song-Yan Liao, MD

    2017-06-01

    Full Text Available Summary: Renal denervation (RD is a potential novel nonpharmacological therapy for heart failure (HF. We performed bilateral catheter-based RD in 10 adult pigs and compared them with 10 control subjects after induction of HF to investigate the long-term beneficial effects of RD on left ventricular (LV function and regional norepinephrine gradient after conventional HF pharmacological therapy. Compared with control subjects, animals treated with RD demonstrated an improvement in LV function and reduction of norepinephrine gradients over the myocardium and kidney at 10-week follow-up. Our results demonstrated that effective bilateral RD decrease regional norepinephrine gradients and improve LV contractile function compared with medical therapy alone. Key Words: heart failure, left ventricular function, norepinephrine, renal denervation

  17. Indices of adrenal deficiency involved in brain plasticity and functional control reorganization in hemodialysis patients with polysulfone membrane: BOLD-fMRI study.

    Science.gov (United States)

    Belaïch, Rachida; Boujraf, Saïd; Benzagmout, Mohammed; Maaroufi, Mustapha; Housni, Abdelkhalek; Batta, Fatima; Tizniti, Siham; Magoul, Rabia; Sqalli, Tarik

    2016-06-01

    This work purpose was to estimate the implication of suspected adrenal function deficiencies, which was influenced by oxidative stress (OS) that are generating brain plasticity, and reorganization of the functional control. This phenomenon was revealed in two-hemodialysis patients described in this paper. Blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) revealed a significant activation of the motor cortex. Hemodialysis seems to originate an inflammatory state of the cerebral tissue reflected by increased OS, while expected to decrease since hemodialysis eliminates free radicals responsible for OS. Considering adrenal function deficiencies, sensitivity to OS and assessed hyponatremia and hypercalcemia, adrenal function deficiencies is strongly suspected in both patients. This probably contributes to amplify brain plasticity and a reorganization of functional control after hemodialysis that is compared to earlier reported studies. Brain plasticity and functional control reorganization was revealed by BOLD-fMRI with a remarkable sensitivity. Brain plastic changes are originated by elevated OS associating indices of adrenal function deficiencies. These results raise important issues about adrenal functional deficiencies impact on brain plasticity in chronic hemodialysis-patients. This motivates more global studies of plasticity induced factors in this category of patients including adrenal functional deficiencies and OS.

  18. Functional deficiency of vitamin K in hemodialysis patients in Upper Silesia in Poland.

    Science.gov (United States)

    Wyskida, Katarzyna; Żak-Gołąb, Agnieszka; Wajda, Jarosław; Klein, Dariusz; Witkowicz, Joanna; Ficek, Rafał; Rotkegel, Sylwia; Spiechowicz, Urszula; Kocemba Dyczek, Joanna; Ciepał, Jarosław; Olszanecka-Glinianowicz, Magdalena; Więcek, Andrzej; Chudek, Jerzy

    2016-05-01

    Functional vitamin K deficiency (both K1 and K2) is postulated to be one of the most relevant links between chronic kidney disease and vascular calcification in hemodialysis (HD) patients. Recommended dietary restrictions in HD patients superimposed on diversity of eating habits across the countries may affect the prevalence of functional vitamin K deficiency. The aim of this study was to determine the level of functional vitamin K deficiency and its relation to vitamin K1 intake in HD patients in Upper Silesia in Poland. Protein-induced vitamin K absence or antagonist-II (PIVKA-II) and undercarboxylated matrix Gla protein (ucMGP) were assessed by ELISA in 153 stable, prevalent HD patients and 20 apparently healthy adults (to establish normal ranges for PIVKA-II and ucMGP). Daily phylloquinone intake was assessed using a food frequency questionnaire. PIVKA-II and ucMGP levels were increased in 27.5 and 77.1 % of HD patients in comparison with the reference ranges in apparently healthy controls, respectively. In 45 % of cases, the increased PIVKA-II level was explained by insufficient phylloquinone intake for Polish population (recommended intake: >55 μg for women and >65 µg for men). Applying ROC analysis, we showed that vitamin K1 intake below 40.2 µg/day was associated with increased PIVKA-II levels. There was no correlation between vitamin K1 intake and plasma concentration of ucMGP, or between PIVKA-II and ucMGP. (1) Functional vitamin K1 deficiency is explained by low vitamin K1 intake in less than half of HD patients. (2) Undercarboxylated matrix Gla protein level is a poor surrogate for functional vitamin K1 deficiency.

  19. Bivalirudin dosing adjustments for reduced renal function with or without hemodialysis in the management of heparin-induced thrombocytopenia.

    Science.gov (United States)

    Tsu, Laura V; Dager, William E

    2011-10-01

    While not approved by the Food and Drug Administration for treatment of heparin-induced thrombocytopenia (HIT), except in patients undergoing percutaneous interventions, the direct thrombin inhibitor bivalirudin is a treatment option that is gaining use. An initial dose of bivalirudin 0.15-0.2 mg/kg/h, adjusted to an activated partial thromboplastin time (aPTT) of 1.5-2.5 times the baseline value, has been suggested. Initial dosing in patients with renal dysfunction, including those on hemodialysis, is unclear. To evaluate initial bivalirudin dosing requirements in patients with and without renal dysfunction, including patients on different forms of dialysis. A retrospective analysis of 135 patients treated with bivalirudin for HIT between June 2004 and October 2009 was conducted at a tertiary care medical center. The patients were divided into groups, based on renal function. Patients receiving dialysis were divided into 3 subgroups based on the mode of hemodialysis: intermittent hemodialysis (IHD, n = 24), sustained low-efficiency daily diafiltration (SLEDD, n = 12), or continuous renal replacement therapy (CRRT, n = 5). Patients not receiving dialysis were separated into 3 subgroups based on calculated creatinine clearance (CrCl): CrCl >60 mL/min (n = 52), CrCl 30-60 mL/min (n = 26), and CrCl 60 mL/min), patients with differing degrees of renal dysfunction (CrCl 30-60 and doses of bivalirudin to achieve aPTT goal (0.13 vs 0.08 vs 0.05 mg/kg/h, respectively; p CRRT) also required dose reductions (0.07, 0.09, and 0.07 mg/kg/h) compared with patients with normal renal function, but higher dosing requirements than patients not receiving dialysis with CrCl dose of bivalirudin to reach a therapeutic aPTT goal. Slightly higher doses may be observed in patients receiving hemodialysis.

  20. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients. © 2015 Wiley Periodicals, Inc.

  1. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

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    Maria Angela Magalhães de Queiroz Carreira

    2015-06-01

    Full Text Available Background: Autonomic dysfunction (AD is highly prevalent in hemodialysis (HD patients and has been implicated in their increased risk of cardiovascular mortality. Objective: To correlate heart rate variability (HRV during exercise treadmill test (ETT with the values obtained when measuring functional aerobic impairment (FAI in HD patients and controls. Methods: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. Results: Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both. A correlation was found between exercise HRV (SDNN and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels. Conclusion: No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls. (Arq Bras Cardiol. 2015; [online]. ahead print, PP.0-0

  2. Temporary Catheter Insertions and Complications in Our Nephrology Clinic: Clinical Experience of One Year

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    Özger Akarsu

    2017-06-01

    Full Text Available Aim: Urgent hemodialysis in patients with renal insufficiency is usually provided by catheter insertions. Early complications of hemodialysis catheter insertions can increase morbidity and mortality. In this study, we investigated the characteristics of patients undergoing temporary hemodialysis catheter insertion in our nephrology clinic and complications. Methods: In this study, we reviewed the records of 151 patients in whom temporary hemodialysis catheters were inserted by the nephrologists of our clinic between August 2012 and August 2013. Demographic features, catheter insertion indications, and catheter insertion sites were assessed and complications were noted. Results: A total of 151 patients (94 female and 57 male were included in the study. The average age of the patients was 58.66±16.8 years (minimum: 17, maximum: 92. No complication was observed in 112 (74.2% patients during catheter insertions. Catheter insertion was repeated in 39 (25.8% patients for various reasons. Arterial puncture occurred in 12 (7.9% of 151 patients who had catheter insertions for the first time. None of the patients required surgical intervention. Conclusion: Temporary catheter insertions are required in patients needing urgent hemodialysis. However, they bring along the risk for many complications. Early referral of patients who require hemodialysis to nephrology clinic and application of permanent vascular interventions will reduce the need for temporary catheters and complications.

  3. The Relationship between Magnesium and Endothelial Function in End-Stage Renal Disease Patients on Hemodialysis

    Science.gov (United States)

    Lee, Shina; Ryu, Jung-Hwa; Kim, Seung-Jung; Ryu, Dong-Ryeol; Kang, Duk-Hee

    2016-01-01

    Purpose Chronic kidney disease (CKD) patients tend to have higher serum magnesium values than healthy population due to their positive balance of magnesium in kidney. Recent studies found that magnesium level is positively correlated with endothelial function. Therefore, this study was conducted to define the relationship between magnesium level and endothelial dysfunction in end stage renal disease (ESRD) patients on hemodialysis (HD). Materials and Methods A total of 27 patients were included in this cross-sectional study. Iontophoresis with laser-Doppler flowmetry, flow mediated dilation (FMD), and carotid intima-media thickness were measured. Patients' average serum magnesium levels were measured over previous three months, including the examination month. Pearson's correlation coefficient analysis and multivariate regression model were used to define the association between magnesium and endothelial function. Results In the univariate analysis, higher magnesium levels were associated with better endothelium-dependent vasodilation (EDV) of the FMD in ESRD patients on HD (r=0.516, p=0.007). When the participants were divided into two groups according to the median magnesium level (3.47 mg/dL), there was a significant difference in EDV of FMD (less than 3.47 mg/dL, 2.8±1.7%; more than 3.47 mg/dL, 5.1±2.0%, p=0.004). In multivariate analysis, magnesium and albumin were identified as independent factors for FMD (β=1.794, p=0.030 for serum magnesium; β=3.642, p=0.012 for albumin). Conclusion This study demonstrated that higher serum magnesium level may be associated with better endothelial function in ESRD patients on HD. In the future, a large, prospective study is needed to elucidate optimal range of serum magnesium levels in ESRD on HD patients. PMID:27593873

  4. Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study.

    Science.gov (United States)

    Hsu, Raymond K; Chai, Boyang; Roy, Jason A; Anderson, Amanda H; Bansal, Nisha; Feldman, Harold I; Go, Alan S; He, Jiang; Horwitz, Edward J; Kusek, John W; Lash, James P; Ojo, Akinlolu; Sondheimer, James H; Townsend, Raymond R; Zhan, Min; Hsu, Chi-Yuan

    2016-08-01

    It is not clear whether the pattern of kidney function decline in patients with chronic kidney disease (CKD) may relate to outcomes after reaching end-stage renal disease (ESRD). We hypothesize that an abrupt decline in kidney function prior to ESRD predicts early death after initiating maintenance hemodialysis therapy. Prospective cohort study. The Chronic Renal Insufficiency Cohort (CRIC) Study enrolled men and women with mild to moderate CKD. For this study, we studied 661 individuals who developed chronic kidney failure that required hemodialysis therapy initiation. The primary predictor was the presence of an abrupt decline in kidney function prior to ESRD. We incorporated annual estimated glomerular filtration rates (eGFRs) into a mixed-effects model to estimate patient-specific eGFRs at 3 months prior to initiation of hemodialysis therapy. Abrupt decline was defined as having an extrapolated eGFR≥30mL/min/1.73m(2) at that time point. All-cause mortality within 1 year after initiating hemodialysis therapy. Multivariable Cox proportional hazards. Among 661 patients with CKD initiating hemodialysis therapy, 56 (8.5%) had an abrupt predialysis decline in kidney function and 69 died within 1 year after initiating hemodialysis therapy. After adjustment for demographics, cardiovascular disease, diabetes, and cancer, abrupt decline in kidney function was associated with a 3-fold higher risk for death within the first year of ESRD (adjusted HR, 3.09; 95% CI, 1.65-5.76). Relatively small number of outcomes; infrequent (yearly) eGFR determinations; lack of more granular clinical data. Abrupt decline in kidney function prior to ESRD occurred in a significant minority of incident hemodialysis patients and predicted early death in ESRD. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.

  5. Catheter Angiography

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    Full Text Available ... few millimeters) in the skin where the catheter can be inserted into an artery. The catheter is ... need for surgery. If surgery remains necessary, it can be performed more accurately. Catheter angiography presents a ...

  6. Catheter Angiography

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    Full Text Available ... x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin plastic ... superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes it ...

  7. Catheter Angiography

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    Full Text Available ... using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin ... called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes ...

  8. Catheter Angiography

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    Full Text Available ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example ...

  9. Catheter Angiography

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    Full Text Available ... What are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical ... top of page What are some common uses of the procedure? Catheter angiography is used to examine ...

  10. Catheter Angiography

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    Full Text Available ... risks? What are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive ... of ionizing radiation ( x-rays ). top of page What are some common uses of the procedure? Catheter ...

  11. Catheter Angiography

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    Full Text Available ... resonance imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into an ... The catheter used in angiography is a long plastic tube about as thick as a strand of ...

  12. Acute kidney injury: effect of hemodialysis membrane on Hgf and recovery of renal function.

    Science.gov (United States)

    Libetta, Carmelo; Esposito, Pasquale; Sepe, Vincenzo; Rampino, Teresa; Zucchi, Manuela; Canevari, Michele; Dal Canton, Antonio

    2013-01-01

    Acute kidney injury (AKI) is associated with a high mortality and morbidity rate. In this study we investigated whether dialysis membranes influence the recovery of renal function, through the regulation of hepatocyte growth factor (HGF). 21 patients were enrolled and assigned to hemodialysis (HD) with cellulose (CE, N=11) versus polymethylacrylate (PMMA, N=10) membranes in alternating order. HGF and IL-1 were measured in serum and in peripheral blood mononuclear cells (PBMC) supernatants collected immediately before the first HD session (T0), at 15 minutes (T15), at 240 minutes (T240) and after the last HD, when renal recovery occurred. Eight healthy volunteers were the controls (CON). Time to renal function recovery was lower in CE than in PMMA patients. Serum HGF in HD patients was significantly higher than in CON. HGF levels were higher in CE than in PMMA patients at T15 (13.4±2.7 vs 8.9±3.0 ng/mL, P=0.004) and T240. At recovery, HGF levels decreased. IL-1 serum levels showed a similar trend (at T15 CE: 20.5±2.9 vs PMMA: 16.9±3.2 pg/mL, P=0.005). HGF release significantly increased in the course of HD, resulting in higher levels in CE than that in PMMA patients. Considering all the patients, basal HGF release negatively correlated with time to renal recovery (r2=0.42, Pprofile in AKI patients, HGF release being higher in patients treated with the CE membrane, in comparison to PMMA. Our results suggest that treatment with CE might improve clinical outcomes, possibly through increased release of HGF. Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  13. Effect of hemodialysis on pulmonary function tests and plasma endothelin levels

    Directory of Open Access Journals (Sweden)

    Javid Safa

    2014-01-01

    Full Text Available End-stage renal disease (ESRD is a complex illness that involves different organs including the lungs. We studied the pulmonary function tests, arterial blood gases (ABG and plasma endothelin-1 (ET-1 levels to check whether there is any change in their levels after hemodialysis (HD in patients with ESRD. In this cross-sectional study (from July 2009 to April 2010, 20 patients with ESRD were evaluated. ABG, spirometric parameters and plasma ET-1 were measured before and after HD in these patients. Student′s t-test was performed to clarify the differences and Pearson′s test was used for correlations. P <0.05 was considered statistically significant. Significant reduction was seen in oxygen saturation (O 2 sat, partial pressure of carbon-dioxide (PaCO 2 and oxygen (PaO 2 after a HD session (P <0.001. Also, improvement was seen in all spirometric parameters except forced expiratory volume (FEV1/forced vital capacity (FVC after HD. Plasma ET-1 levels decreased signi-ficantly after HD. Mean ET-1 before HD was 6.88 + 5.81 pg/mL while it was 3.91 + 2.76 pg/mL after HD (P = 0.009. Based on the plasma levels of ET-1, the patients were divided into two groups. The mean level of ET-1 was higher in the first group. Significant increase was seen in spirometric parameters in the second group. Our study suggests that, in patients with ESRD, plasma ET-1 level is higher than in the normal population, and this is closely related to deterioration of pulmonary function tests. Significant reduction of plasma ET-1 may be an important factor in the improvement of spiro-metry parameters after HD.

  14. EFFECTS OF A RESPIRATORY PHYSIOTHERAPY PROTOCOL ON PULMONARY CAPACITY, FUNCTIONAL CAPACITY AND QUALITY OF LIFE IN HEMODIALYSIS PATIENTS

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    Bruna Taynara dos Santos Ribeiro

    2015-02-01

    Full Text Available Chronic kidney disease and own dialysis can result in changes in almost all body systems. In the respiratory system, the changes affect the respiratory drive, lung mechanics, muscle strength and gas exchange. Respiratory physiotherapy may be an important strategy in improving lung function and welfare and satisfaction of patients. The aim of the study was to determine the effects of a program of respiratory physiotherapy in lung capacity, functional capacity and quality of life of patients with chronic kidney disease on hemodialysis. The lung capacity, functional capacity and quality of life were evaluated by the manovacuometer, chest cirtometry, functional capacity's questionnaire (HAQ-20 and specific questionnaire of quality of life for kidney disease (KDOQOL-SF. Patients were evaluated before and after eight weeks of application of respiratory physiotherapy protocol, performed once a week. The study included five patients, four men and one woman, mean age 60 ± 11,29 and an average of hemodialysis treatment of 24 ± 20.35 months. The values obtained in lung capacity and functional capacity presented unchanged. It was observed that the respiratory physiotherapy influenced the improvement of the KDQOL-SF's scores, of the dimensions "Sleep", "Dialysis Staff Encouragement" and "Physical Functioning".

  15. Effects of a respiratory physiotherapy protocol on pulmonary capacity, functional capacity and quality of life in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Bruna Taynara dos Santos Ribeiro

    2014-10-01

    Full Text Available Chronic kidney disease and own dialysis can result in changes in almost all body systems. In the respiratory system, the changes affect the respiratory drive, lung mechanics, muscle strength and gas exchange. Respiratory physiotherapy may be an important strategy in improving lung function and welfare and satisfaction of patients. The aim of the study was to determine the effects of a program of respiratory physiotherapy in lung capacity, functional capacity and quality of life of patients with chronic kidney disease on hemodialysis. The lung capacity, functional capacity and quality of life were evaluated by the manovacuometer, chest cirtometry, functional capacity's questionnaire (HAQ-20 and specific questionnaire of quality of life for kidney disease (KDOQOL-SF. Patients were evaluated before and after eight weeks of application of respiratory physiotherapy protocol, performed once a week. The study included five patients, four men and one woman, mean age 60 ± 11,29 and an average of hemodialysis treatment of 24 ± 20.35 months. The values obtained in lung capacity and functional capacity presented unchanged. It was observed that the respiratory physiotherapy influenced the improvement of the KDQOL-SF's scores, of the dimensions "Sleep", "Dialysis Staff Encouragement" and "Physical Functioning".

  16. Nutritional status in nocturnal hemodialysis

    NARCIS (Netherlands)

    Ipema, Jacoba Regina

    2016-01-01

    Malnutrition is extremely prevalent in hemodialysis patients and may result in loss of muscle mass and poor physical functioning. Malnutrition is also a major predictor of increased morbidity and mortality. The central theme of this thesis is how the transition from conventional hemodialysis to

  17. Safe removal of an epidural catheter 72 hours after clopidogrel and aspirin administrations guided by platelet function analysis and thromboelastography

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    Eric Glenn

    2013-01-01

    Full Text Available Management of neuraxial anesthesia/analgesia in anticoagulated patient can be challenging. The shortest safe time to remove epidural catheter, after a patient receives long-acting dual antiplatelet agents (clopidogrel and aspirin, is unclear. American Society of Regional Anesthesiology (ASRA guidelines recommend seven days interval for the epidural placement after clopidogrel administration. However ASRA Guideline did not specify the time for epidural catheter removal, and did not specify how much time elapse necessary after dual antiplatelet therapy with clopidogrel and aspirin. We report a case of safe removal of epidural catheter 72 hours after oral dose of clopidogrel and aspirin with a normal platelet function analysis and normal thromboelastography before removal.

  18. Efficacy and safety of intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients: a meta-analysis.

    Science.gov (United States)

    Susantitaphong, Paweena; Alqahtani, Fahad; Jaber, Bertrand L

    2014-01-01

    Studies on benefits of intravenous iron therapy among hemodialysis patients with functional iron deficiency anemia have shown conflicting results. We conducted a meta-analysis to assess the efficacy and safety of intravenous iron in this subset of patients. We searched MEDLINE (through December 2012), the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCT) that examined the effect of intravenous iron for functional iron deficiency anemia in hemodialysis patients on anemia parameters and markers of oxidative stress and inflammation. Studies of absolute iron deficiency were excluded. Random-effect model meta-analyses were used to compute changes in outcomes of interest. We identified 34 studies (2,658 patients), representing 24 single-arm studies, and 10 parallel-arm RCT. In the analyses of the study arms, intravenous iron therapy resulted in a significant increase in hemoglobin, serum ferritin, transferrin saturation rate, serum iron, reticulocyte hemoglobin content as well as a significant decrease in the percentage of hypochromic erythrocytes and erythropoietin dose. There were significant increases in plasma malonyldialdehyde level and thiobarbituric acid-reactive substances, and a decrease in neutrophil respiratory burst. The analyses of the RCT revealed less robust net changes in these parameters, and there was no increased risk of adverse events including infections, cardiac events and mortality. Intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients improves anemia parameters but exerts some effects on markers of oxidative stress that are of unclear clinical significance. The long-term safety and efficacy of this treatment strategy requires further study.

  19. [Project work: formation of health-care personnel for self-care of tunnelled central venous catheters in hemodialysis patients of the territory].

    Science.gov (United States)

    Morale, Walter; Patanè, D; Incardona, C; Seminara, G; Malfa, P; L'Anfusa, G; Calcara, G; Bisceglie, P; Puliatti, D; Di Landro, D

    2013-01-01

    Scientific data from current literature demonstrate an incidence of bacteraemia due to tunnelled central venous catheter (tCVC) use accounting for 1.6 / 1000 days per tCVC, with a range of 1.5 to 1.8. In Sicily no data on the incidence of tCVC- related bacteraemia are available. In our hospital, tCVC infection occurs 2.4 times in 1000 days during CVC use. A retrospective analysis carried out from 2006 to 2012 was performed on 650 patients with tunnelled catheters. Of the subjects who received tCVC in our hospital, 90% were destined to undergo haemodialysis in a private health care environment outside our hospital. In order to improve the aforementioned infection outcome, we planned and implemented a specific work project. The work project (WP) was subdivided into two steps: 1) The first step was further subdivided into two sub-phases. The first was principally concerned with the implementation of educational courses, conducted directly on the ward and aimed at the implementation of meticulous nursing regimes for the care of tCVC by our health care nurse. The courses were entitled Management of Vascular Access: from doing - to teaching to do!. These educational courses were organized by the Nephrology Department, which takes care of the management and handling of the major complications of tCVCs for the maintenance of haemodialysis. After this first step, the nurses who had participated became the promoters of the second part of the course, which concerned the development of know-how within an outpatient clinic, which deals exclusively with the nursing management of tCVCs. 2) The title of the second phase was Therapeutic Education: self-Care and understanding and managing your venous access at home. The aim of this step was the integration of correct in-hospital care with that available in outsourced private institutions, via the involvement of the patient in the management of their own central venous access. During our training project, a more detailed analysis of

  20. Kidney Transplantation Is Superior to Hemodialysis and Peritoneal Dialysis in Terms of Cognitive Function, Anxiety, and Depression Symptoms in Chronic Kidney Disease.

    Science.gov (United States)

    Ozcan, H; Yucel, A; Avşar, U Z; Cankaya, E; Yucel, N; Gözübüyük, H; Eren, F; Keles, M; Aydınlı, B

    2015-06-01

    Cognitive impairment, anxiety and depression are important problems for patients with chronic kidney failure. Cognitive impairment, anxiety, and depression may be related to various factors, such as complications of hemo/peritoneal dialysis, uremic encephalopathy, psychosocial burden of the disease, and various comorbidities in patients with chronic kidney failure. Successful kidney transplantation (KT) improves kidney, endocrine, metabolic, and vascular systems, mental functions, and the quality of life of the patients. A total of 181 patients with chronic kidney failure were studied: 54 currently on hemodialysis, 58 on peritoneal dialysis, and 69 with KT. All participants were given a detailed sociodemographic form, including data about the reason of kidney failure, duration of treatment (hemodialysis, peritoneal dialysis, and KT), and comorbid illnesses. Participants were evaluated with the use of the Hospital Anxiety and Depression Scale (HADS) for evaluating depressive and anxiety symptoms and the Brief Cognitive State Examination (BCSE) for detecting possible cognitive impairment. Patients with KT had lower levels of anxiety and depression symptoms than patients with hemodialysis and peritoneal dialysis. The KT group scored better than the hemodialysis and peritoneal dialysis groups on the BCSE. The peritoneal dialysis group scored higher on the BCSE than the hemodialysis group. The hemodialysis group scored higher on the HADS than the peritoneal dialysis group. In this study it was found that KT patients have better cognitive and mood regulation outcomes than hemodialysis and peritoneal dialysis patients with chronic kidney failure. With this knowledge we suggest that patients with kidney failure should have KT for having better cognitive functions and mood state as soon as possible. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Catheter Angiography

    Medline Plus

    Full Text Available ... Z Catheter Angiography Catheter angiography uses a catheter, x-ray imaging guidance and an injection of contrast material ... vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging ( ...

  2. Aerobic training during hemodialysis improves body composition, muscle function, physical performance, and quality of life in chronic kidney disease patients.

    Science.gov (United States)

    Bae, Young-Hyeon; Lee, Suk Min; Jo, Jong Il

    2015-05-01

    [Purpose] We assessed the influences of individualized aerobic training on body composition, knee joint muscle function, physical performance, and quality of life in chronic kidney disease patients. [Subjects] Ten chronic kidney disease patients undergoing dialysis. [Methods] Overall physical function and quality of life before and after 12 weeks of aerobic training were evaluated by body composition, the six-minute walk test, cardiopulmonary exercise tests, and Short Form 36-item questionnaire. [Results] The six-minute walk test distance increased significantly after 12 weeks aerobic training. Resting metabolic rate, lactate threshold, maximum oxygen uptake, and quality of life tended to increase after training. Post-training weight, muscle mass, body fat mass, fat percentage, body mass index, and peak torque of right and left knee extension and flexion did not change significantly. [Conclusion] Intra-dialytic training can a safe approach to maintain or improve physical performance and quality of life of chronic kidney disease patients undergoing hemodialysis without adverse events or negative cardiovascular responses. Aerobic training may prevent a decline in body composition and knee joint muscle function due to inactivity in chronic kidney disease patients. Clinically, aerobic training may initially be adapted to maintain overall physical function or improve quality of life in chronic kidney disease patients undergoing hemodialysis.

  3. Cognitive-psychomotor functions and nutritional status in maintenance hemodialysis patients: are they related?

    Science.gov (United States)

    Radić, Josipa; Ljutic, Dragan; Radić, Mislav; Kovacic, Vedran; Curković, Katarina Dodig; Sain, Milenka

    2011-12-01

    Both cognitive impairment and malnutrition are common in hemodialysis patients and associated with adverse clinical outcome. The aim of the study was to investigate performance on a detailed cognitive and psychomotor battery in maintenance hemodialysis patients in correlation to nutritional status. A selected population of 65 adult (20 females and 45 males, aged 57.84±12.28 years) hemodialysis (4.78±3.62 years) patients were investigated. The total time of test solving was correlated with Dialysis Malnutrition Score (DMS) in tests of simple visual discrimination of signal location (r=0.215, P=0.042), simple convergent visual orientation (r=0.262, P=0.020), and convergent thinking (r=0.244, P=0.034). The minimum time of test solving was also correlated with DMS in the test of simple convergent visual orientation (r=0.227, P=0.038), and in the test of convergent thinking (r=0.223, P=0.048). Total ballast, as a descriptor of stability in reaction time, was correlated with DMS in the test of simple visual discrimination of signal location (r=0.281, P=0.012), and in a test of short term memory actualization (r=0.239, P=0.028). Furthermore, significant correlation was noted between body mass index, serum creatinine, total cholesterol and albumin level with cognitive-psychomotor performance. Hemodialysis patients with a poorer nutritional status performed worse on cognitive and psychomotor tests. Further research is needed to assess the effects of treating malnutrition on cognitive-psychomotor performance in these patients. © 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis.

  4. Correlation analysis of high precision blood flow imaging in secondary parathyroid function in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Wen-Ze Du

    2016-12-01

    Full Text Available Objective: To investigate the value of high precision blood flow imaging (Fine-Flow in secondary parathyroid function (SHPT in patients with maintenance hemodialysis (MHD. Methods: A total of 95 MHD patients with SHPT in our hospital from January 2015 to June 2016 were selected as the research object. According to the Fine-Flow examination of parathyroid gland, 73 cases were divided into display group, 22 cases were not shown; Display group according to the hyperplasia of parathyroid diameter were divided into 1.5 cm group of 17 cases; display group according to the blood flow into the rich group of 41 cases, not rich group of 32 cases; according to whether calcification were divided into calcification group of 43 cases, non calcified group of 30 cases. CDFI was used for the anterior region of neck transverse and longitudinal scanning, check the thyroid and around the dorsal lobes.The size, echo, lesion number and blood flow were measured, parathyroid hormone (PTH, serum calcium (Ca, phosphorus (P, and calculate the Ca and P product (Ca×P were measured. Results: PTH and Ca of the display group were significantly higher than that of the non display group, and differences in P and Ca×P were not statistically significant; Parathyroid diameter >1.5 cm PTH levels were significantly higher than the other three groups, diameter 1-1.5 cm group and >1.5 cm group Ca, diameter Ca×P was higher than that in group <5 cm and 0.5-1.0 cm group, difference in P of four groups was not statistical significant; group PTH, P, abundant blood flow Ca×P were not significantly higher than the rich group, difference in P of two groups was no statistical significance; group Ca was significantly higher than that of calcification calcification group, differences in PTH, P, Ca×P of the two groups were not statistically significant. Conclusions: MHD patients with SHPT, parathyroid Fine-Flow display rate is high, and has the characteristic performance. Its operation is

  5. Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients.

    Science.gov (United States)

    Beberashvili, Ilia; Azar, Ada; Sinuani, Inna; Shapiro, Gregory; Feldman, Leonid; Sandbank, Judith; Stav, Kobi; Efrati, Shai

    2016-12-01

    The geriatric nutritional risk index (GNRI) has been reported as a useful predictor of prognosis in maintenance hemodialysis (MHD) patients, demonstrating GNRI less than 90 as a marker of a poorer nutritional status and significantly increased mortality. We tested whether GNRI as a whole associated stronger with clinical and laboratory surrogates of nutrition and inflammation, muscle function, health-related quality of life (QoL), and predicts all-cause and cardiovascular (CV) morbidity and mortality in this population better than its individual components (albumin and body weight to ideal body weight ratio). A prospective observational study with a median follow-up of 30 months (interquartile range - 19-41 months) was performed on 352 MHD outpatients (38.0% women) with a mean age of 67.4 ± 13.2 years. All-cause and cardiovascular hospitalization and mortality, GNRI, handgrip strength (HGS), body composition parameters (anthropometry and bioimpedance) and short form 36 (SF-36) quality-of-life scores were measured. Multivariate linear regression analyses were performed to obtain adjusted correlations. Receiver operating characteristic (ROC) curves were generated and multivariate Cox proportional hazards models were applied to identify the predictive value of GNRI and its components separately. GNRI positively correlated with total score (r = 0.15, P patients didn't stand up to multivariable adjustments. For each one unit increase in baseline GNRI levels, the first hospitalization hazard ratio (HR) after adjustments for confounders was 0.98 (95% confidence interval (CI), 0.97 to 0.99) and the first CV event HR was 0.98 (95% CI, 0.97 to 0.99); all-cause death HR was 0.97 (95% CI, 0.96 to 0.99) and CV death HR was 0.97 (95% CI, 0.95-0.99). Albumin was related to QoL and clinical outcomes with higher strength and magnitude than GNRI. Despite the significant relationship with clinical outcomes and QOL, GNRI is not better and is even slightly worse than albumin

  6. The Association of Long-Functioning Hemodialysis Vascular Access with Prevalence of Left Ventricular Hypertrophy in Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Aureliusz Kolonko

    2014-01-01

    Full Text Available Left ventricular hypertrophy (LVH is frequently observed in chronic dialysis patients and is also highly prevalent in kidney transplant recipients. This study evaluates the impact of long-functioning hemodialysis vascular access on LVH in single center cohort of kidney transplant recipients. 162 patients at 8.7 ± 1.8 years after kidney transplantation were enrolled. Echocardiography, carotid ultrasound, and assessment of pulse wave velocity were performed. LVH was defined based on left ventricular mass (LVM indexed for body surface area (BSA and height2.7. There were 67 patients with and 95 without patent vascular access. Both study groups were comparable with respect to gender, age, duration of dialysis therapy, and time after transplantation, kidney graft function, and cardiovascular comorbidities. Patients with patent vascular access were characterized by significantly elevated LVM and significantly greater percentage of LVH, based on LVMI/BSA (66.7 versus 48.4%, P=0.02. OR for LVH in patients with patent vascular access was 2.39 (1.19–4.76, P=0.01. Regression analyses confirmed an independent contribution of patent vascular access to higher LVM and increased prevalence of LVH. We concluded that long-lasting patent hemodialysis vascular access after kidney transplantation is associated with the increased prevalence of LVH in kidney transplant recipients.

  7. Home Hemodialysis

    Science.gov (United States)

    ... weeks of home hemodialysis training. Diet and Liquids Strict limits on liquids, phosphorus, sodium, and potassium Fewer ... Health Information Diabetes Digestive Diseases Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition ...

  8. Severe Tricuspid Valve Endocarditis Related to Tunneled Catheters ...

    African Journals Online (AJOL)

    Introduction: Hemodialysis (HD) patients are predisposed to infective endocarditis (IE) mainly due to repeated manipulation of the vascular access. However, catheter seeding and IE may also result from a distant infection site. Case series: A diabetic patient who was maintained on regular HD through a permanent catheter ...

  9. Home hemodialysis

    DEFF Research Database (Denmark)

    Agar, John W; Perkins, Anthony; Heaf, James G

    2015-01-01

    We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use.......We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use....

  10. Catheter Angiography

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    Full Text Available ... Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, ... a tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of ...

  11. Catheter Angiography

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    Full Text Available ... What are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical ... them appear bright white. top of page How is the procedure performed? This examination is usually done ...

  12. Catheter Angiography

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    Full Text Available ... an artery through a small incision in the skin. Once the catheter is guided to the area ... small incision (usually a few millimeters) in the skin where the catheter can be inserted into an ...

  13. Catheter Angiography

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    Full Text Available ... magnetic resonance imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into ... through the body, recording an image on photographic film or a special detector. Different parts of the ...

  14. Catheter Angiography

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    Full Text Available ... imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into an artery ... examined, a contrast material is injected through the tube and images are captured using a small dose ...

  15. Catheter Angiography

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    Full Text Available ... it will make the rest of the procedure pain-free. You will not feel the catheter in ... nurse if you notice any bleeding, swelling or pain at the site where the catheter entered the ...

  16. Assessment of Arteriovenous Shunt Pathway Function and Hypervolemia for Hemodialysis Patients by Using Integrated Rapid Screening System

    Directory of Open Access Journals (Sweden)

    Wei-Ling Chen

    2017-06-01

    Full Text Available Currently, the hemodialysis patients received body weight measurement by themselves, vital sign checking by nursing staffs before dialysis. Whenever, the arteriovenous routes with problems doubted, the patients needed to be referred to surgeon for vascular echography checking and then to be corrected. How to integrate these three tasks in one time is a very important issue. The project proposes to combine our previous study of audio-phono angiographic technology in detecting vascular stenosis with rapid screening system to evaluate dialysis patients’ arteriovenous routes function and their status of excess body fluids: inspecting and integrating the blood pressure, body weight, and fistula function work into a rapid screening system, and using the quantization of fistula phono angiography pitch to achieve assessing arteriovenous routes. Future hoping is developed a complete integrated intelligence system by combining the arteriovenous fistula signal processing with feature extraction with wireless sensor network technology.

  17. Catheter Angiography

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    Full Text Available ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography produces very ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example is finding ...

  18. New technology: heparin and antimicrobial-coated catheters.

    Science.gov (United States)

    Ibeas-Lopez, Jose

    2015-01-01

    Although tunneled hemodialysis catheter must be considered the last option for vascular access, it is necessary in some circumstances in the dialysis patient. Thrombosis and infections are the main causes of catheter-related comorbidity. Fibrin sheath, intimately related with the biofilm, is the precipitating factor of this environment, determining catheter patency and patient morbidity. Its association with bacterial overgrowth and thrombosis has led to the search of multiple preventive measures. Among them is the development of catheter coatings to prevent thrombosis and infections. There are two kinds of treatments to cover the catheter surface: antithrombotic and antimicrobial coatings. In nondialysis-related settings, mainly in intensive care units, both have been shown to be efficient in the prevention of catheter-related infection. This includes heparin, silver, chlorhexidine, rifampicine and minocycline. In hemodialysis population, however, few studies on surface-treated catheters have been made and they do not provide evidence that shows complication reduction. The higher effectiveness of coatings in nontunneled catheters may depend on the short average life of these devices. Hemodialysis catheters need to be used over long periods of time and require clinical trials to show effectiveness of coatings over long periods. This also means greater knowledge of biofilm etiopathogeny and fibrin sheath development.

  19. Evaluation of a continuous blood glucose monitoring system using a central venous catheter with an integrated microdialysis function.

    Science.gov (United States)

    Schierenbeck, Fanny; Öwall, Anders; Franco-Cereceda, Anders; Liska, Jan

    2013-01-01

    Glycemic control in critically ill patients has been the topic of an interesting debate during the last decade. An accurate continuous glucose monitoring system is essential to better understand this field. This prospective study thus evaluates the accuracy and technical feasibility of a continuous glucose monitoring system using intravascular microdialysis. Thirty patients undergoing cardiac surgery were monitored using a triple-lumen central venous catheter (Eirus TLC; Eirus Medical AB, Solna, Sweden) with an integrated microdialysis function. The catheter functions as a central venous catheter, enabling blood sampling and administration of infusions and medication while simultaneously providing continuous glucose monitoring. The patients were monitored for up to 48 h postoperatively. As reference, arterial blood gas samples were taken every hour and analyzed in a blood gas analyzer. Six hundred seven paired samples were obtained for analysis. Using Clarke Error Grid analysis, 100% of the paired samples were in Zones A+B, and 97% were in Zone A. Mean difference (bias) was -0.12 mmol/L, and mean absolute relative difference was 5.6%. Of the paired samples, 97.5% were correct according to International Organization for Standardization criteria. Bland-Altman analysis showed bias ± limits of agreement were -0.12 ± 0.7 mmol/L. No hypoglycemic episodes were observed. Central venous microdialysis is an accurate and reliable method for continuous blood glucose monitoring up to 48 h in patients undergoing cardiac surgery. With the microdialysis function integrated in a central venous catheter, no extra device for the continuous glucose monitoring is required. The system may be useful in critically ill patients.

  20. Regional homogeneity changes in hemodialysis patients with end stage renal disease: in vivo resting-state functional MRI study.

    Directory of Open Access Journals (Sweden)

    Cheng Li

    Full Text Available OBJECTIVE: To prospectively investigate and detect early cerebral regional homogeneity (ReHo changes in neurologically asymptomatic patients with end stage renal disease (ESRD using in vivo resting-state functional MR imaging (Rs-fMRI. METHODS: We enrolled 20 patients (15 men, 5 women; meanage, 37.1 years; range, 19-49 years with ESRD and 20 healthy controls (15 men, 5 women; mean age, 38.3 years; range, 28-49 years. The mean duration of hemodialysis for the patient group was 10.7±6.4 monthes. There was no significant sex or age difference between the ESRD and control groups. Rs-fMRI was performed using a gradient-echo echo-planar imaging sequence. ReHo was calculated using software (DPARSF. Voxel-based analysis of the ReHo maps between ESRD and control groups was performed with a two-samples t test. Statistical maps were set at P value less than 0.05 and were corrected for multiple comparisons. The Mini-Mental State Examination (MMSE was administered to all participants at imaging. RESULTS: ReHo values were increased in the bilateral superior temporal gyrus and left medial frontal gyrus in the ERSD group compared with controls, but a significantly decreased ReHo value was found in the right middle temporal gyrus. There was no significant correlation between ReHo values and the duration of hemodialysis in the ESRD group. Both the patients and control subjects had normal MMSE scores (≥28. CONCLUSIONS: Our finding revealed that abnormal brain activity was distributed mainly in the memory and cognition related cotices in patients with ESRD. The abnormal spontaneous neuronal activity in those areas provide information on the neural mechanisms underlying cognitive impairment in patients with ESRD, and demonstrate that Rs-fMRI with ReHo analysis is a useful non-invasive imaging tool for the detection of early cerebral ReHo changes in hemodialysis patients with ESRD.

  1. Regional homogeneity changes in hemodialysis patients with end stage renal disease: in vivo resting-state functional MRI study.

    Science.gov (United States)

    Li, Cheng; Su, Huan-Huan; Qiu, Ying-Wei; Lv, Xiao-Fei; Shen, Sheng; Zhan, Wen-Feng; Tian, Jun-Zhang; Jiang, Gui-Hua

    2014-01-01

    To prospectively investigate and detect early cerebral regional homogeneity (ReHo) changes in neurologically asymptomatic patients with end stage renal disease (ESRD) using in vivo resting-state functional MR imaging (Rs-fMRI). We enrolled 20 patients (15 men, 5 women; meanage, 37.1 years; range, 19-49 years) with ESRD and 20 healthy controls (15 men, 5 women; mean age, 38.3 years; range, 28-49 years). The mean duration of hemodialysis for the patient group was 10.7±6.4 monthes. There was no significant sex or age difference between the ESRD and control groups. Rs-fMRI was performed using a gradient-echo echo-planar imaging sequence. ReHo was calculated using software (DPARSF). Voxel-based analysis of the ReHo maps between ESRD and control groups was performed with a two-samples t test. Statistical maps were set at P value less than 0.05 and were corrected for multiple comparisons. The Mini-Mental State Examination (MMSE) was administered to all participants at imaging. ReHo values were increased in the bilateral superior temporal gyrus and left medial frontal gyrus in the ERSD group compared with controls, but a significantly decreased ReHo value was found in the right middle temporal gyrus. There was no significant correlation between ReHo values and the duration of hemodialysis in the ESRD group. Both the patients and control subjects had normal MMSE scores (≥28). Our finding revealed that abnormal brain activity was distributed mainly in the memory and cognition related cotices in patients with ESRD. The abnormal spontaneous neuronal activity in those areas provide information on the neural mechanisms underlying cognitive impairment in patients with ESRD, and demonstrate that Rs-fMRI with ReHo analysis is a useful non-invasive imaging tool for the detection of early cerebral ReHo changes in hemodialysis patients with ESRD.

  2. Vascular Access for Hemodialysis

    Science.gov (United States)

    ... Adequacy Eating & Nutrition for Hemodialysis Vascular Access for Hemodialysis What is a vascular access? A vascular access ... Set Up the Vascular Access Well before Starting Hemodialysis Patients should set up a vascular access well ...

  3. Cloxacillin as an antibiotic lock solution for prevention of catheter-associated infection.

    Science.gov (United States)

    Davanipur, Mozhgan; Pakfetrat, Maryam; Roozbeh, Jamishid

    2011-09-01

    Catheter-related infection is associated with increased all-cause mortality and morbidity in hemodialysis patients. This study aimed to evaluate an antimicrobial lock solution (cloxacillin and heparin) in temporary noncuffed double-lumen catheters for long-term intermittent hemodialysis as a method of preventing catheter-related infection. Patients on hemodialysis with noncuffed temporary double lumen catheter were randomly divided into 2 groups. Fifty patients received a solution containing cloxacillin, 100 mg/mL, plus heparin, 1000 IU/mL as a 2.5-mL solution instilled in each of catheter lumens after dialysis session. Another 50 patients received only heparin. They were allowed to dwell until the next session of dialysis. One catheter-related bacteremia was observed in the antibiotic group whereas catheter-related bacteremia was observed in 8 of those who received heparin only. The rate of catheter-related bacteremia episodes were 0.5 per 1000 catheter-days in the antibiotic group versus 7.8 per 1000 catheter-days in the control group (P = .02). In the present study, application of cloxacillin as antibiotic lock solution for dialysis catheters resulted in a considerable reduction in catheter-related bacteremia rate.

  4. Catheter Angiography

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter ...

  5. Catheter Angiography

    Medline Plus

    Full Text Available ... that blood will form a clot around the tip of the catheter, blocking the artery and making it necessary to operate to reopen the vessel. If you have diabetes or kidney disease, the kidneys may be injured due to the ... that the catheter tip will separate material from the inner lining of ...

  6. Catheter Angiography

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography ...

  7. Catheter Angiography

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    Full Text Available ... is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is removed and the incision site is closed by applying pressure on the area for approximately 10 to 20 ...

  8. Transcutaneous intravascular transposition of a permanent dialysis catheter

    Science.gov (United States)

    Piecuch, Jerzy; Jacheć, Wojciech; Szrot, Monika; Krzak, Albert

    2014-01-01

    Permanent catheters are used to provide long-lasting access for long-term dialysis therapy in certain patients when creating an arteriovenous fistula between their own vessels is not possible, when there are contraindications for fistula creation or when the expected lifetime of the patient is short. We present the case of a patient with terminal renal insufficiency treated with hemodialysis for 5 years. Due to post-thrombotic changes and venous stenosis resulting from long-term cannulation with dialysis catheters, the replacement catheter was inserted through the previously used canal and transcutaneous intravascular catheter transposition was performed. PMID:25337180

  9. Functional Polymorphisms in Matrix Metalloproteinases-1, -3, -9 are Associated with Arteriovenous Fistula Patency in Hemodialysis Patients

    OpenAIRE

    Lin, Chih-Ching; Yang, Wu-Chang; Chung, Ming-Yi; Lee, Pui-Ching

    2010-01-01

    Background and objectives: Matrix metalloproteinases (MMPs) are risk factors for cardiovascular diseases. This study evaluated the association of genotype polymorphisms of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in hemodialysis (HD) patients with arteriovenous fistula (AVF) failure.

  10. CENTRAL VENOUS CATHETER AS A VASCULAR APPROACH TO HEMODIALYSTS

    Directory of Open Access Journals (Sweden)

    Verica Djordjevic

    2001-03-01

    Full Text Available The application of the central venous catheter (CVC as a temporary orpermanent vascular approach to hemodialysis has been practiced in our Center since1994. So far 30 (12,6% patients have been thus treated. The primary application hasbeen done in 25 patients, namely: the first making of the A V fistula has been done in16, the ABT in 6, while the vascular approach correction in 3 patients. The secondaryapplication has been done in 5 patients. The infection episode incidence concerningthe CVC application is 20 infections per 1.000 patients. This is the upper limitaccording to the data given in the literature (5, rang 3-20. The average duration of thecatheter is 21 + - 13 days (rang 1-47. Two-volume catheters have been used for ajugular approach though less often for a femoral one. The unsuccessful placing due tothe catheter thrombosis has occurred in 4 patients, the catheter drop-out and itsreplacing have been done in 2 patients, while no replacement has happened in onečaše. The treatment has been stopped in one patient. Tn four patients the cerebrovascularinsult has happened after placing the CVC. The mortality rate is 26,6%,that is, K patients, namely: 4 due to cerebrovascular insult, one due to lung emboly,one due to heart weakness and one due to the sepsis from the V fistula. One patientdied at home for unknown reason. A high infection episode incidence rate is related toinadequate patients' placing so that their location in the rooms for intensive care is away of reducing it. It is necessary to provide for general aseptic procedure at work aswell as for betterment of the accompanying procedures (hemoculture, antibiograms,sterilization in order to maintain a safe catheter function.

  11. Standardized Definitions for Hemodialysis Vascular Access

    OpenAIRE

    Lee, Timmy; Mokrzycki, Michele; Moist, Louise; Maya, Ivan; Vazquez, Miguel; Lok, Charmaine

    2011-01-01

    Vascular access dysfunction is one of the leading causes of morbidity and mortality among end-stage renal disease patients 1,2. Vascular access dysfunction exists in all 3 types of available accesses: arteriovenous fistulas, arteriovenous grafts, and tunneled catheters. In order to improve clinical research and outcomes in hemodialysis access dysfunction, the development of a multidisciplinary network of collaborative investigators with various areas of expertise, and common standards for ter...

  12. Antimicrobial activity and cytocompatibility of silver nanoparticles coated catheters via a biomimetic surface functionalization strategy

    Science.gov (United States)

    Wu, Ke; Yang, Yun; Zhang, Yanmei; Deng, Jiexi; Lin, Changjian

    2015-01-01

    Catheter-related bloodstream infections are a significant problem in the clinic and may result in a serious infection. Here, we developed a facile and green procedure for buildup of silver nanoparticles (AgNPs) on the central venous catheters (CVCs) surface. Inspired by mussel adhesive proteins, dopamine was used to form a thin polydopamine layer and induce AgNPs formation without additional reductants or stabilizers. The chemical and physicochemical properties of AgNPs coated CVCs were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, and water contact angle. The Staphylococcus aureus culture experiment was used to study the antibacterial properties. The cytocompatibility was assessed by water soluble tetrazolium salts (WST-1) assay, fluorescence staining, and scanning electron microscopy analysis. The results indicated that the CVCs surface was successfully coated with compact AgNPs. AgNPs were significantly well separated and spherical with a size of 30–50 nm. The density of AgNPs could be modulated by the concentration of silver nitrate solution. The antibacterial activity was dependent on the AgNPs dose. The high dose of AgNPs showed excellent antibacterial activity while associated with increased cytotoxicity. The appropriate density of AgNPs coated CVCs could exhibit improved biocompatibility and maintained evident sterilization effect. It is promising to design mussel-inspired silver releasing CVCs with both significant antimicrobial efficacy and appropriate biological safety. PMID:26664115

  13. Catheter Angiography

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    Full Text Available ... may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or ... it will make the rest of the procedure pain-free. You will not feel the catheter in ...

  14. Catheter Angiography

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    Full Text Available ... rays ). top of page What are some common uses of the procedure? Catheter angiography is used to ... pelvis legs and feet arms and hands Physicians use the procedure to: identify abnormalities, such as aneurysms, ...

  15. Catheter Angiography

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    Full Text Available ... is suspended over a table on which the patient lies. The catheter used in angiography is a ... other noninvasive procedures. No radiation remains in a patient's body after an x-ray examination. X-rays ...

  16. Catheter Angiography

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    Full Text Available ... examine blood vessels in key areas of the body for abnormalities such as aneurysms and disease such ... to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters ...

  17. Catheter Angiography

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    Full Text Available ... catheter angiography to lessen the risk of allergic reaction. Another option is to undergo a different exam ... and its references. The risk of serious allergic reaction to contrast materials that contain iodine is extremely ...

  18. Catheter Angiography

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    Full Text Available ... a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels in ... technologies and, in most cases, a contrast material injection is needed to produce pictures of blood vessels ...

  19. Umbilical catheters

    Science.gov (United States)

    ... baby is very premature. The baby has bowel problems that prevent feeding. The baby needs very strong medicines. The baby needs exchange transfusion. HOW ARE UMBILICAL CATHETERS PLACED? There are normally ...

  20. Catheter Angiography

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    Full Text Available ... basis. A nurse or technologist will insert an intravenous (IV) line into a small vein in your ... all the necessary images have been obtained. Your intravenous line will be removed. A catheter angiogram may ...

  1. Catheter Angiography

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    Full Text Available ... you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking and allergies, especially ... is Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical ...

  2. Catheter Angiography

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    Full Text Available ... machine produces a small burst of radiation that passes through the body, recording an image on photographic ... By selecting the arteries through which the catheter passes, it is possible to assess vessels in several ...

  3. Catheter Angiography

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    Full Text Available ... disease). evaluate obstructions of vessels. top of page How should I prepare? You should inform your physician ... as a strand of spaghetti. top of page How does the procedure work? Catheter angiography works much ...

  4. Catheter Angiography

    Science.gov (United States)

    ... 24 hours before catheter angiography to lessen the risk of allergic reaction. Another option is to undergo a different ... Manual on Contrast Media and its references. The risk of serious allergic reaction to contrast materials that contain iodine is ...

  5. Catheter Angiography

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    Full Text Available ... contrast material to examine blood vessels in key areas of the body for abnormalities such as aneurysms ... skin. Once the catheter is guided to the area being examined, a contrast material is injected through ...

  6. Catheter Angiography

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    Full Text Available ... atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a ... the aorta in the chest or abdomen or its major branches. show the extent and severity of ...

  7. Catheter Angiography

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    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... obstructions of vessels. top of page How should I prepare? You should inform your physician of any ...

  8. Catheter Angiography

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    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... and x-rays. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 ...

  9. Catheter Angiography

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    Full Text Available ... Catheter angiography produces very detailed, clear and accurate pictures of the blood vessels and may eliminate the ... a contrast material injection is needed to produce pictures of blood vessels in the body. Angiography is ...

  10. Catheter Angiography

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    Full Text Available ... heart chest abdomen (such as the kidneys and liver) pelvis legs and feet arms and hands Physicians ... Angiography (CTA) X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored ...

  11. Catheter Angiography

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    Full Text Available ... The catheter used in angiography is a long plastic tube about as thick as a strand of ... will be drawn before starting the procedure to make sure that your kidneys are working and that ...

  12. Catheter Angiography

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    Full Text Available ... before catheter angiography to lessen the risk of allergic reaction. Another option is to undergo a different exam ... Media and its references. The risk of serious allergic reaction to contrast materials that contain iodine is extremely ...

  13. Catheter Angiography

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    Full Text Available ... story about radiology? Share your patient story here Images × Image Gallery Interventional radiologist performing an angiography exam View ... ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored by Please note ...

  14. Catheter Angiography

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    Full Text Available ... such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes it possible ... and abdomen, or in other arteries. detect atherosclerotic (plaque) disease in the carotid artery of the neck, ...

  15. Catheter Angiography

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    Full Text Available ... than an hour away. top of page What does the equipment look like? The equipment typically used ... a strand of spaghetti. top of page How does the procedure work? Catheter angiography works much the ...

  16. Catheter Angiography

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    Full Text Available ... other procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the aorta in ... small incision (usually a few millimeters) in the skin where the catheter can be inserted into an ...

  17. Catheter Angiography

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    Full Text Available ... far outweighs the risk. If you have a history of allergy to x-ray contrast material, your ... Angiography (CTA) X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored ...

  18. Catheter Angiography

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    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... an hour away. top of page What does the equipment look like? The equipment typically used for ...

  19. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis.

    Science.gov (United States)

    Iyasere, Osasuyi U; Brown, Edwina A; Johansson, Lina; Huson, Les; Smee, Joanna; Maxwell, Alexander P; Farrington, Ken; Davenport, Andrew

    2016-03-07

    In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; Pdialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices. Copyright © 2016 by the American Society of Nephrology.

  20. Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient.

    Science.gov (United States)

    Cleper, Roxana; Goldenberg-Cohen, Nitza; Kornreich, Liora; Krause, Irit; Davidovits, Miriam

    2007-09-01

    Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.

  1. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...

  2. Hepcidin-25 in chronic hemodialysis patients is related to residual kidney function and not to treatment with erythropoiesis stimulating agents.

    Directory of Open Access Journals (Sweden)

    Neelke C van der Weerd

    Full Text Available Hepcidin-25, the bioactive form of hepcidin, is a key regulator of iron homeostasis as it induces internalization and degradation of ferroportin, a cellular iron exporter on enterocytes, macrophages and hepatocytes. Hepcidin levels are increased in chronic hemodialysis (HD patients, but as of yet, limited information on factors associated with hepcidin-25 in these patients is available. In the current cross-sectional study, potential patient-, laboratory- and treatment-related determinants of serum hepcidin-20 and -25, were assessed in a large cohort of stable, prevalent HD patients. Baseline data from 405 patients (62% male; age 63.7 ± 13.9 [mean SD] enrolled in the CONvective TRAnsport STudy (CONTRAST; NCT00205556 were studied. Predialysis hepcidin concentrations were measured centrally with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patient-, laboratory- and treatment related characteristics were entered in a backward multivariable linear regression model. Hepcidin-25 levels were independently and positively associated with ferritin (p<0.001, hsCRP (p<0.001 and the presence of diabetes (p = 0.02 and inversely with the estimated glomerular filtration rate (p = 0.01, absolute reticulocyte count (p = 0.02 and soluble transferrin receptor (p<0.001. Men had lower hepcidin-25 levels as compared to women (p = 0.03. Hepcidin-25 was not associated with the maintenance dose of erythropoiesis stimulating agents (ESA or iron therapy. In conclusion, in the currently studied cohort of chronic HD patients, hepcidin-25 was a marker for iron stores and erythropoiesis and was associated with inflammation. Furthermore, hepcidin-25 levels were influenced by residual kidney function. Hepcidin-25 did not reflect ESA or iron dose in chronic stable HD patients on maintenance therapy. These results suggest that hepcidin is involved in the pathophysiological pathway of renal anemia and iron availability in these patients, but

  3. Comparison of the impact of high-flux dialysis on mortality in hemodialysis patients with and without residual renal function.

    Science.gov (United States)

    Kim, Hyung Wook; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

    2014-01-01

    The effect of flux membranes on mortality in hemodialysis (HD) patients is controversial. Residual renal function (RRF) has shown to not only be as a predictor of mortality but also a contributor to β2-microglobulin clearance in HD patients. Our study aimed to determine the interaction of residual renal function with dialyzer membrane flux on mortality in HD patients. HD Patients were included from the Clinical Research Center registry for End Stage Renal Disease, a prospective observational cohort study in Korea. Cox proportional hazards regression models were used to study the association between use of high-flux dialysis membranes and all-cause mortality with RRF and without RRF. The primary outcome was all-cause mortality. This study included 893 patients with 24 h-residual urine volume ≥100 ml (569 and 324 dialyzed using low-flux and high-flux dialysis membranes, respectively) and 913 patients with 24 h-residual urine volume dialysis membranes, respectively). After a median follow-up period of 31 months, mortality was not significantly different between the high and low-flux groups in patients with 24 h-residual urine volume ≥100 ml (HR 0.86, 95% CI, 0.38-1.95, P = 0.723). In patients with 24 h-residual urine volume dialysis membrane was associated with decreased mortality compared to HD using low-flux dialysis membrane in multivariate analysis (HR 0.40, 95% CI, 0.21-0.78, P = 0.007). Our data showed that HD using high-flux dialysis membranes had a survival benefit in patients with 24 h-residual urine volume dialysis rather than low-flux dialysis might be considered in HD patients without RRF.

  4. Short- and long-term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access

    NARCIS (Netherlands)

    J. van der Linden (Joke); J.H. Smits (Johannes); J.H. Assink (Jan Hendrik); D.W. Wolterbeek (Derk); J.J. Zijlstra (Jan); G.H.T. de Jong (Gijs); M.A. van den Dorpel (Marinus); P.J. Blankestijn (Peter)

    2002-01-01

    textabstractThe efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and

  5. Oxidative Stress in Hemodialysis Patients: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Vassilios Liakopoulos

    2017-01-01

    Full Text Available Hemodialysis (HD patients are at high risk for all-cause mortality and cardiovascular events. In addition to traditional risk factors, excessive oxidative stress (OS and chronic inflammation emerge as novel and major contributors to accelerated atherosclerosis and elevated mortality. OS is defined as the imbalance between antioxidant defense mechanisms and oxidant products, the latter overwhelming the former. OS appears in early stages of chronic kidney disease (CKD, advances along with worsening of renal failure, and is further exacerbated by the HD process per se. HD patients manifest excessive OS status due to retention of a plethora of toxins, subsidized under uremia, nutrition lacking antioxidants and turn-over of antioxidants, loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. Duration of dialysis therapy, iron infusion, anemia, presence of central venous catheter, and bioincompatible dialyzers are several factors triggering the development of OS. Antioxidant supplementation may take an overall protective role, even at early stages of CKD, to halt the deterioration of kidney function and antagonize systemic inflammation. Unfortunately, clinical studies have not yielded unequivocal positive outcomes when antioxidants have been administered to hemodialysis patients, likely due to their heterogeneous clinical conditions and underlying risk profile.

  6. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Directory of Open Access Journals (Sweden)

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  7. Principles of tunneled cuffed catheter placement.

    Science.gov (United States)

    Heberlein, Wolf

    2011-12-01

    Tunneled cuffed catheters provide reliable and instant long-term intravenous access for a large variety of therapeutic purposes, including chemotherapy, parenteral nutrition, and apheresis. The most frequent application is for patients with renal failure as an access device for hemodialysis. In this capacity, the rate of catheter use has remained stable in the United States, despite the promotion of arteriovenous fistulas and arteriovenous grafts. The latter 2 procedures achieve superior longevity and much higher cost-efficiency. Tunneled catheters, however, serve as bridging devices during maturation of newly placed arteriovenous fistulas or as the final option in patients in whom fistulas and grafts have failed. High-quality vascular access is a hallmark of interventional radiology, and its significance for patient care and for our specialty cannot be overestimated. Familiarity with basic concepts of the device and procedural techniques are crucial to achieve successful long-term venous access. The following article demonstrates key concepts of tunneled venous catheter placement by means of dialysis, inasmuch as dialysis catheters represent the most commonly placed tunneled central venous catheters. The principles of placement and techniques utilized, however, are applicable to devices that are used for chemotherapy or parenteral nutrition, such as the Hickman, Broviac, Groshong, or tunneled peripherally inserted central catheters. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Urinary catheter - infants

    Science.gov (United States)

    Bladder catheter - infants; Foley catheter - infants; Urinary catheter - neonatal ... A urinary catheter is a small, soft tube placed in the bladder. This ... are not making much urine. Babies can have low urine output ...

  9. The relation between Internet and social media use and the demographic and clinical parameters, quality of life, depression, cognitive function and sleep quality in hemodialysis patients: social media and hemodialysis.

    Science.gov (United States)

    Afsar, Baris

    2013-01-01

    There are very few studies in the literature investigating the Internet use in hemodialysis (HD) patients. However, no study examined the relationship between Internet and social media use and quality of life, depression, cognitive function and sleep problems in HD patients. The study is cross-sectional in design. All patients underwent history taking; physical examination; laboratory analysis and quality of life (by a short form of the Medical Outcomes Study), depression (by the Beck Depression Inventory), cognitive function (by the Standardized Mini Mental State Examination) and sleep problems (by the Pittsburgh Sleep Quality Index) evaluation. In total, 134 HD patients (male/female: 73/61, age: 53.0 ± 13.4 years) were included. Patients with mail, Facebook and Twitter accounts were younger, were less depressive, had better quality of life, had higher cognitive function and were more educated compared to patients who did not have these accounts. Patients with Internet-based research about their disease were less depressive, had better quality of life and sleep quality, had higher cognitive function and were more educated compared to patients who did not have Internet-based research. Internet and social media use was closely related with quality of life, depression, cognitive function and education in HD patients. Studies are needed on whether Internet use under the supervision of health care professionals will improve clinical outcomes, adherence, quality of life, depression and decision making in HD patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Short- and long-term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access

    NARCIS (Netherlands)

    Van der Linden, J; Smits, JHM; Wolterbeek, DW; Zijlstra, JJ; De Jong, GHT; Van den Dorpel, MA; Blankestijn, PJ

    The efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and angiographic effects of PTA and to determine

  11. Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit.

    Science.gov (United States)

    Damluji, Abdulla; Zanni, Jennifer M; Mantheiy, Earl; Colantuoni, Elizabeth; Kho, Michelle E; Needham, Dale M

    2013-08-01

    Femoral catheters pose a potential barrier to early rehabilitation in the intensive care unit (ICU) due to concerns, such as catheter removal, local trauma, bleeding, and infection. We prospectively evaluated the feasibility and safety of physical therapy (PT) in ICU patients with femoral catheters. We evaluated consecutive medical ICU patients who received PT with a femoral venous, arterial, or hemodialysis catheter(s) in situ. Of 1074 consecutive patients, 239 (22%) received a femoral catheter (81% venous, 29% arterial, 6% hemodialysis; some patients had >1 catheter). Of those, 101 (42%) received PT interventions, while the catheter was in situ, for a total of 253 sessions over 210 medical ICU (MICU) days. On these 210 MICU days, the highest daily activity level achieved was 49 (23%) standing or walking, 57 (27%) sitting, 25 (12%) supine cycle ergometry, and 79 (38%) in-bed exercises. During 253 PT sessions, there were no catheter-related adverse events giving a 0% event rate (95% upper confidence limit of 2.1% for venous catheters). Physical therapy interventions in MICU patients with in situ femoral catheters appear to be feasible and safe. The presence of a femoral catheter should not automatically restrict ICU patients to bed rest. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Catheter Angiography

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. ...

  13. Catheter Angiography

    Medline Plus

    Full Text Available ... treat medical conditions. Angiography uses one of three imaging technologies and, in most cases, a contrast material injection is needed to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging ( ...

  14. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a regular x-ray ... material injection, you should immediately inform the technologist. Women should always inform their physician or x-ray ...

  15. Catheter Angiography

    Medline Plus

    Full Text Available ... 24 hours before catheter angiography to lessen the risk of allergic reaction. Another option is to undergo a different ... Manual on Contrast Media and its references. The risk of serious allergic reaction to contrast materials that contain iodine is ...

  16. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a regular x-ray ... any possibility that they are pregnant. See the Safety page for more information about pregnancy and x- ...

  17. Catheter Angiography

    Medline Plus

    Full Text Available ... your radiologist may advise that you take special medication for 24 hours before catheter angiography to lessen the risk of allergic reaction. Another option is to undergo a different exam that does not call for contrast material injection. If a large amount of x-ray contrast ...

  18. Catheter Angiography

    Medline Plus

    Full Text Available ... contrast material, your radiologist may advise that you take special medication for 24 hours before catheter angiography ... the artery, causing a block downstream in the blood vessel. top of page What are the ... information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. ...

  19. The Effect of Renal Function and Hemodialysis Treatment on Plasma Vasopressin and Copeptin Levels

    NARCIS (Netherlands)

    Ettema, Esmée M; Heida, Judith; Casteleijn, Niek F; Boesten, Lianne; Westerhuis, Ralf; Gaillard, Carlo A J M; Gansevoort, Ron T; Franssen, Casper F M; Zittema, Debbie

    2017-01-01

    Introduction: Copeptin is increasingly used in epidemiological studies as a substitute for vasopressin. The effect of renal function per se on copeptin and vasopressin concentrations as well as their ratio have, however, not been well described. Methods: Copeptin and vasopressin levels were measured

  20. The kidney disease quality of life cognitive function subscale and cognitive performance maintenance hemodialysis patients

    Science.gov (United States)

    Background: Cognitive impairment is common but often undiagnosed in patients with end-stage renal disease, in part reflecting limited validated and easily administered tools to assess cognitive function in dialysis patients. Accordingly, we assessed the utility of the Kidney Disease Quality of Life ...

  1. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction.

    Science.gov (United States)

    Clark, Katherine; Chick, Jeffrey Forris Beecham; Reddy, Shilpa N; Shin, Benjamin J; Nadolski, Gregory J; Clark, Timothy W; Trerotola, Scott O

    2017-04-01

    To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  2. Infrequent dialysis: a new paradigm for hemodialysis initiation.

    Science.gov (United States)

    Rhee, Connie M; Unruh, Mark; Chen, Jing; Kovesdy, Csaba P; Zager, Phillip; Kalantar-Zadeh, Kamyar

    2013-01-01

    Nearly a half-century ago, the thrice-weekly hemodialysis schedule was empirically established as a means to provide an adequate dialysis dose while also treating the greatest number of end-stage renal disease (ESRD) patients using limited resources. Landmark trials of hemodialysis adequacy have historically been anchored to thrice-weekly regimens, but a recent randomized controlled trial demonstrated that frequent hemodialysis (six times per week) confers cardiovascular and survival benefits. Based on these collective data and experience, clinical practice guidelines advise against a less than thrice-weekly treatment schedule in patients without residual renal function, yet provide limited guidance on the optimal treatment frequency when substantial native kidney function is present. Thus, during the transition from Stage 5 chronic kidney disease to ESRD, the current paradigm is to initiate hemodialysis on a "full-dose" thrice-weekly regimen even among patients with substantial residual renal function. However, emerging data suggest that frequent hemodialysis accelerates residual renal function decline, and infrequent regimens may provide better preservation of native kidney function. Given the high mortality rates during the first 6 months of hemodialysis and the survival benefits of preserved native kidney function, initiation with twice-weekly treatment schedules ("infrequent hemodialysis") with an incremental increase in frequency over time may provide an opportunity to optimize patient survival. This review outlines the clinical benefits of post-hemodialysis residual renal function, studies of twice-weekly treatment regimens, and the potential risks and benefits of infrequent hemodialysis. © 2013 Wiley Periodicals, Inc.

  3. Association between initial vascular access and survival in hemodialysis according to age.

    Science.gov (United States)

    Kim, Ha Yeon; Bae, Eun Hui; Ma, Seong Kwon; Kim, Soo Wan

    2017-11-20

    This study aims to demonstrate whether the association between initial vascular access and mortality among hemodialysis patients varies by age. We conducted a retrospective study that included 2,552 patients who started hemodialysis. Vascular access was divided into three categories: percutaneous catheter, tunneled cuffed catheter, and arteriovenous (AV) access. Survival rates for patients who received a central venous catheter, such as percutaneous or tunneled cuffed catheter, aged 65 to 74 years and those ≥ 75 years were reduced, but not for those aged access decreased (94.1%, 90.5%, and 80.3% for patients aged vascular access was associated with long-term mortality. We suggest that a "fistula first" strategy is superior for elderly patients and demonstrates that it is desirable to change to AV access, and not maintain an initial central vascular catheter.

  4. Robotic positioning of standard electrophysiology catheters: a novel approach to catheter robotics.

    Science.gov (United States)

    Knight, Bradley; Ayers, Gregory M; Cohen, Todd J

    2008-05-01

    Robotic systems have been developed to manipulate and position electrophysiology (EP) catheters remotely. One limitation of existing systems is their requirement for specialized catheters or sheaths. We evaluated a system (Catheter Robotics Remote Catheter Manipulation System [RCMS], Catheter Robotics, Inc., Budd Lake, New Jersey) that manipulates conventional EP catheters placed through standard introducer sheaths. The remote controller functions much like the EP catheter handle, and the system permits repeated catheter disengagement for manual manipulation without requiring removal of the catheter from the body. This study tested the hypothesis that the RCMS would be able to safely and effectively position catheters at various intracardiac sites and obtain thresholds and electrograms similar to those obtained with manual catheter manipulation. Two identical 7 Fr catheters (Blazer II; Boston Scientific Corp., Natick, Massachusetts) were inserted into the right femoral veins of 6 mongrel dogs through separate, standard 7 Fr sheaths. The first catheter was manually placed at a right ventricular endocardial site. The second catheter handle was placed in the mating holder of the RCMS and moved to approximately the same site as the first catheter using the Catheter Robotics RCMS. The pacing threshold was determined for each catheter. This sequence was performed at 2 right atrial and 2 right ventricular sites. The distance between the manually and robotically placed catheters tips was measured, and pacing thresholds and His-bundle recordings were compared. The heart was inspected at necropsy for signs of cardiac perforation or injury. Compared to manual positioning, remote catheter placement produced the same pacing threshold at 7/24 sites, a lower threshold at 11/24 sites, and a higher threshold at only 6/24 sites (p > 0.05). The average distance between catheter tips was 0.46 +/- 0.32 cm (median 0.32, range 0.13-1.16 cm). There was no difference between right atrial

  5. Blood flow measurement using digital subtraction angiography for assessing hemodialysis access function

    Science.gov (United States)

    Koirala, Nischal; Setser, Randolph M.; Bullen, Jennifer; McLennan, Gordon

    2017-03-01

    Blood flow rate is a critical parameter for diagnosing dialysis access function during fistulography where a flow rate of 600 ml/min in arteriovenous graft or 400-500 ml/min in arteriovenous fistula is considered the clinical threshold for fully functioning access. In this study, a flow rate computational model for calculating intra-access flow to evaluate dialysis access patency was developed and validated in an in vitro set up using digital subtraction angiography. Flow rates were computed by tracking the bolus through two regions of interest using cross correlation (XCOR) and mean arrival time (MAT) algorithms, and correlated versus an in-line transonic flow meter measurement. The mean difference (mean +/- standard deviation) between XCOR and in-line flow measurements for in vitro setup at 3, 6, 7.5 and 10 frames/s was 118+/-63 37+/-59 31+/-31 and 46+/-57 ml/min respectively while for MAT method it was 86+/-56 57+/-72 35+/-85 and 19+/-129 ml/min respectively. The result of this investigation will be helpful for selecting candidate algorithms while blood flow computational tool is developed for clinical application.

  6. Validation of T-Track® CMV to assess the functionality of cytomegalovirus-reactive cell-mediated immunity in hemodialysis patients.

    Science.gov (United States)

    Banas, Bernhard; Böger, Carsten A; Lückhoff, Gerhard; Krüger, Bernd; Barabas, Sascha; Batzilla, Julia; Schemmerer, Mathias; Köstler, Josef; Bendfeldt, Hanna; Rascle, Anne; Wagner, Ralf; Deml, Ludwig; Leicht, Joachim; Krämer, Bernhard K

    2017-03-07

    Uncontrolled cytomegalovirus (CMV) replication in immunocompromised solid-organ transplant recipients is a clinically relevant issue and an indication of impaired CMV-specific cell-mediated immunity (CMI). Primary aim of this study was to assess the suitability of the immune monitoring tool T-Track® CMV to determine CMV-reactive CMI in a cohort of hemodialysis patients representative of patients eligible for renal transplantation. Positive and negative agreement of T-Track® CMV with CMV serology was examined in 124 hemodialysis patients, of whom 67 (54%) revealed a positive CMV serostatus. Secondary aim of the study was to evaluate T-Track® CMV performance against two unrelated CMV-specific CMI monitoring assays, QuantiFERON®-CMV and a cocktail of six class I iTAg™ MHC Tetramers. Positive T-Track® CMV results were obtained in 90% (60/67) of CMV-seropositive hemodialysis patients. In comparison, 73% (45/62) and 77% (40/52) positive agreement with CMV serology was achieved using QuantiFERON®-CMV and iTAg™ MHC Tetramer. Positive T-Track® CMV responses in CMV-seropositive patients were dominated by pp65-reactive cells (58/67 [87%]), while IE-1-responsive cells contributed to an improved (87% to 90%) positive agreement of T-Track® CMV with CMV serology. Interestingly, T-Track® CMV, QuantiFERON®-CMV and iTAg™ MHC Tetramers showed 79% (45/57), 87% (48/55) and 93% (42/45) negative agreement with serology, respectively, and a strong inter-assay variability. Notably, T-Track® CMV was able to detect IE-1-reactive cells in blood samples of patients with a negative CMV serology, suggesting either a previous exposure to CMV that yielded a cellular but no humoral immune response, or TCR cross-reactivity with foreign antigens, both suggesting a possible protective immunity against CMV in these patients. T-Track® CMV is a highly sensitive assay, enabling the functional assessment of CMV-responsive cells in hemodialysis patients prior to renal transplantation. T

  7. Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction.

    Directory of Open Access Journals (Sweden)

    Maojing Wang

    Full Text Available To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC in patients with persistent atrial fibrillation (AF and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation.From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF 20% or to over 55% in 31 (54.39% patients with worse baseline cardiac function and ventricular rate control.Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group.

  8. Alternate hemodialysis access in patients with occluded peripheral venous access sites; Alternative Zugangswege fuer Haemodialysekatheter bei Patienten mit verschlossenen peripheren venoesen Zugangswegen

    Energy Technology Data Exchange (ETDEWEB)

    Wacker, F.K. [Klinik und Hochschulambulanz fuer Radiologie und Nuklearmedizin, Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin (Germany); Dept. of Radiology, Univ. Hospitals of Cleveland, Case Western Reserve Univ., Cleveland, OH (United States); LiPuma, J.; Blum, A. [Dept. of Radiology, Univ. Hospitals of Cleveland, Case Western Reserve Univ., Cleveland, OH (United States)

    2005-08-01

    Purpose: the goal of this study was to evaluate translumbar and transhepatic placement of hemodialysis (HD) catheters for patients with occlusion of the veins that are commonly used for hemodialysis access. Method: over a 12-month period three translumbar and one transhepatic hemodialysis catheters were placed in 4 patients suffering from end-stage renal disease, who had thrombosis of the upper and lower extremity veins as well as the jugular veins. The percutaneous access was performed under fluoroscopic guidance. After successful passage of a guidewire into the right atrium and creation of a subcutaneous tunnel at the skin entry site, all patients received a 14 F double-lumen catheter that was placed with its tip in the right atrium. Results: percutaneous translumbar and transhepatic placement of the HD catheters was successful in all patients. No intervention-associated complications were observed. Hemodialysis could be started 1 to 20 hours after initial catheter placement in all patients. During an observation period of 3 to 7 months, 3 patients underwent hemodialysis without any complications. In one patient, an occlusion of an translumbar HD catheter was observed after 5 months. This catheter could be temporarily recanalized using rTPA injection and was then exchanged after 6 months. Conclusion: transhepatic and translumbar placement of HD catheters is a safe and viable alternative for patients who have exhausted conventional venous access sites. (orig.)

  9. Proteomic Investigations into Hemodialysis Therapy

    Directory of Open Access Journals (Sweden)

    Mario Bonomini

    2015-12-01

    Full Text Available The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane’s performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane’s bio(incompatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research.

  10. Proteomic Investigations into Hemodialysis Therapy.

    Science.gov (United States)

    Bonomini, Mario; Sirolli, Vittorio; Pieroni, Luisa; Felaco, Paolo; Amoroso, Luigi; Urbani, Andrea

    2015-12-10

    The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane's performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane's bio(in)compatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research.

  11. Analysis of vascular access in hemodialysis patients: a report from a dialysis unit in Casablanca.

    Science.gov (United States)

    Medkouri, Ghislaine; Aghai, Rachid; Anabi, Aabdelkbir; Yazidi, Asma; Benghanem, Mohamed G; Hachim, Khadija; Ramdani, Benyounes; Zaid, Driss

    2006-12-01

    Vascular access (VA) for patients needing maintenance hemodialysis (HD) remains a major obstacle in the management of patients with end-stage renal disease (ESRD). We retrospectively analyzed 190 patients, (92 males and 98 females) who had been on HD for a period ranging from 12 to 240 months. Their mean age was 42.8 years (range: 13 to 83 years). The study was carried out to analyze the VA, including the management of its complications. The cause of renal failure was chronic glomerulonephritis in 34.2% and unknown in 30.5% of the study cases. In 164 patients (86.3%), HD was initiated through a temporary catheter inserted in the internal jugular vein. Each patient had, on an average, two catheters inserted that lasted for a mean duration of 29 days. All patients had a native arteriovenous fistula (AVF) as the permanent VA. A primary radial-cephalic AVF was created in 96.3% of the patients. The median period before cannulation was 15 days. Failure of AVF function occurred in 18.4% of cases while the median survival of the primary AVF was 54.8 months. Thrombosis, seen in 26.4% of the patients, was the predominant complication, and this event seemed to be causally related to prior insertion of temporary catheters. Ten patients had arterio-venous grafts (AVG) placed due to recurrent thrombosis of the AVF. The AVG was brachial-cephalic in five patients. A tunneled cuffed catheter was placed in four patients who had no other possible access sites available. These catheters were placed in the right internal jugular vein in all of these patients. The success of VA in patients on HD requires a multi-disciplinary approach and early referral to a vascular surgeon

  12. Functional status of hemodialysis arteriovenous fistula in kidney transplant recipients as a predictor of allograft function and survival.

    Science.gov (United States)

    Vajdič, B; Arnol, M; Ponikvar, R; Kandus, A; Buturović-Ponikvar, J

    2010-12-01

    There is no accepted policy for preserving or ligating arteriovenous fistula (AVF) after successful kidney transplantation. The aim of this study was to compare kidney graft function and survival between patients with a functional AVF at 1 year after-transplantation with those having a nonfunctional AVF. This historical cohort study included 311 kidney transplant recipients between January 2000 and December 2008 with a functional AVF at the time of transplantation. Patients were divided into 2 groups according to functional status of AVF at 1 year after transplantation. Graft function was assessed at 1 year by serum creatinine and estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease formula. Kaplan-Meier and Cox proportional hazards analyses were used to assess the relationship between the functional status of the AVF and graft survival. The 311 recipients had a mean age of 47 ± 11 years (range, 14 to 70) with 188 (60.5%) males. Patients with functional AVF at 1 year (n = 239) showed higher serum creatinine and lower eGFR values than those with nonfunctional AVF (n = 72): namely 110 ± 38 μmol/L and 69 ± 21 mL/min/1.73 m(2) versus 99 ± 30 μmol/L and 74 ± 19 mL/min/1.73 m(2), respectively (P functional AVF at 1 year after transplantation was associated with a greater incidence of eGFR functional AVF versus 75% among those with a nonfunctional AVF (P = .045). The adjusted analyses revealed the persistence of a functional AVF to be associated with an increased risk for future allograft loss (hazard ratio, 1.336; 95% CI, 1.018-1.755; P = .037). In conclusion, the persistence of a functional AVF was associated with a lower eGFR at 1 year after-transplantation and an increased risk for future allograft loss. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Restoration of parathyroid function after change of phosphate binder from calcium carbonate to lanthanum carbonate in hemodialysis patients with suppressed serum parathyroid hormone.

    Science.gov (United States)

    Inaba, Masaaki; Okuno, Senji; Nagayama, Harumi; Yamada, Shinsuke; Ishimura, Eiji; Imanishi, Yasuo; Shoji, Shigeichi

    2015-03-01

    Control of phosphate is the most critical in the treatment of chronic kidney disease with mineral and bone disorder (CKD-MBD). Because calcium-containing phosphate binder to CKD patients is known to induce adynamic bone disease with ectopic calcification by increasing calcium load, we examined the effect of lanthanum carbonate (LaC), a non-calcium containing phosphate binder, to restore bone turnover in 27 hemodialysis patients with suppressed parathyroid function (serum intact parathyroid hormone [iPTH] ≦ 150 pg/mL). At the initiation of LaC administration, the dose of calcium-containing phosphate binder calcium carbonate (CaC) was withdrawn or reduced based on serum phosphate. After initiation of LaC administration, serum calcium and phosphate decreased significantly by 4 weeks, whereas whole PTH and iPTH increased. A significant and positive correlation between decreases of serum calcium, but not phosphate, with increases of whole PTH and iPTH, suggested that the decline in serum calcium with reduction of calcium load by LaC might increase parathyroid function. Serum bone resorption markers, such as serum tartrate-resistant acid phosphatase 5b, and N-telopeptide of type I collagen increased significantly by 4 weeks after LaC administration, which was followed by increases of serum bone formation markers including serum bone alkaline phosphatase, intact procollagen N-propeptide, and osteocalcin. Therefore, it was suggested that LaC attenuated CaC-induced suppression of parathyroid function and bone turnover by decreasing calcium load. In conclusion, replacement of CaC with LaC, either partially or totally, could increase parathyroid function and resultant bone turnover in hemodialysis patients with serum iPTH ≦ 150 pg/mL. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  14. Tunnel unroofing effectiveness in chronic peritoneal catheter infection

    Directory of Open Access Journals (Sweden)

    Lorena Carranza

    2017-04-01

    Full Text Available Introduction: Chronic catheter infection usually involves external Dacron cuff colonization, without its removal, antibiotic treatment proved ineffective. Catheter unroofing technique has been described as an alternative to peritoneal catheter removal. Material and methods: We analyzed the data from 13 patients retrospectively. Evolution after unroofing was evaluated, considering as treatment failure the appearance of new infection in the hole, tunnel or peritonitis associated to the same germ. Results: Between 1997-2014 years, unroofing was performed on 13 patients. Mean age-rate: 46.2 (IC 95%: 35.9 years – 56.5 years male sex 9, 69.23%. Germs: staphylococcus 7, pseudomona 2, polymicrobial 1, negative culture 3. Nine patiens healed: 69.2%; there was no statistical association among sex, age, microbiological result, previous hemodialysis use, type of catheter, surgical technique or with the surgeon who performed the procedure (p≥ 0.05. Discussion: Catheter removal implies transient transference to hemodialysis and new replacement surgery, although there is few experience with this technique, it could be an acceptable alternative, enabling a group of patients to continue with PD treatment. Conclusion: Unroofing technique proved to be beneficial in 69.2% of the cases (9 patients independently of the type of germ present, representing an acceptable treatment which avoids catheter removal, enabling the procedure to continue, and decreasing the need to employ more aggressive therapies.

  15. Sodium citrate versus heparin catheter locks for cuffed central venous catheters: a single-center randomized controlled trial.

    Science.gov (United States)

    Power, Albert; Duncan, Neill; Singh, Seema K; Brown, Wendy; Dalby, Elizabeth; Edwards, Claire; Lynch, Kathleen; Prout, Virginia; Cairns, Tom; Griffith, Megan; McLean, Adam; Palmer, Andrew; Taube, David

    2009-06-01

    Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock have suggested its efficacy in preventing infection and bleeding complications compared with sodium heparin. Open-label randomized controlled trial of 2 catheter locks to examine the hypothesis that sodium citrate catheter locks will reduce catheter-related bacteremia and exit-site infection. 232 consenting long-term hemodialysis patients in 4 satellite dialysis units to a large dialysis program with protocolized treatment and targets. All patients were using twin-catheter single-lumen Tesio-Caths (MedComp, Harleysville, PA). 6 months' use of 46.7% sodium citrate (citrate) or 5% heparin (heparin) locked postdialysis in the dead space of the central venous catheter. Primary end point of catheter-related bacteremia and exit-site infection. Secondary end points of catheter thrombosis defined by the use of urokinase lock and infusion, new catheter insertion, catheter-related admission, blood transfusions, parenteral iron, and erythropoietin requirements. Catheter-related bacteremia did not differ in the 2 groups, with an incidence of 0.7 events/1,000 catheter-days. There was no significant difference in rates of exit-site infection (0.7 versus 0.5 events/1,000 catheter-days; P = 0.5). The secondary end point of catheter thrombosis defined by the use of a urokinase lock was significantly more common in the citrate group, with an incidence of 8 versus 4.3/1,000 catheter-days (P < 0.001). Other secondary end points did not differ. Citrate treatment was curtailed compared with heparin because of a greater incidence of adverse events, with a mean treatment duration before withdrawal of 4.8 +/- 2.0 versus 5.7 +/- 1.2 months, respectively (P < 0.001). Low baseline catheter-related bacteremia and exit-site infection event rates may have underpowered this study. High adverse-event rates may have been related to high

  16. Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation.

    Science.gov (United States)

    Nührich, Jana M; Geisler, Anne C; Steven, Daniel; Hoffmann, Boris A; Schäffer, Benjamin; Lund, Gunnar; Stehning, Christian; Radunski, Ulf K; Sultan, Arian; Schwarzl, Michael; Adam, Gerhard; Willems, Stephan; Muellerleile, Kai

    2017-02-01

    Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage-mapping after multiple persAF ablation procedures. We included 16 persAF patients who had ≥2 SM procedures and a control group (CG) of 21 persAF patients without prior ablation. CMR was performed in sinus rhythm at least 4 weeks after the last cardioversion. Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude scar burden to be higher (40 [20-68] vs nine [3-18] %, P scar burden after multiple extensive persAF ablations. ©2016 Wiley Periodicals, Inc.

  17. Case study: An unusual cause of clotted blood in epidural catheter ...

    African Journals Online (AJOL)

    The failure of an epidural catheter after initially functioning well may be due to kinking, knotting or epidural catheter lumen blockage. The presence of blood in the epidural catheter is usually due to the catheter's traumatic placement or to intravascular migration. We describe an unusual cause of blood in the epidural catheter ...

  18. Catheter-based Intramyocardial Injection of FGF1 or NRG1-loaded MPs Improves Cardiac Function in a Preclinical Model of Ischemia-Reperfusion

    Science.gov (United States)

    Garbayo, Elisa; Gavira, Juan José; de Yebenes, Manuel Garcia; Pelacho, Beatriz; Abizanda, Gloria; Lana, Hugo; Blanco-Prieto, María José; Prosper, Felipe

    2016-05-01

    Cardiovascular protein therapeutics such as neuregulin (NRG1) and acidic-fibroblast growth factor (FGF1) requires new formulation strategies that allow for sustained bioavailability of the drug in the infarcted myocardium. However, there is no FDA-approved injectable protein delivery platform due to translational concerns about biomaterial administration through cardiac catheters. We therefore sought to evaluate the efficacy of percutaneous intramyocardial injection of poly(lactic-co-glycolic acid) microparticles (MPs) loaded with NRG1 and FGF1 using the NOGA MYOSTAR injection catheter in a porcine model of ischemia-reperfusion. NRG1- and FGF1-loaded MPs were prepared using a multiple emulsion solvent-evaporation technique. Infarcted pigs were treated one week after ischemia-reperfusion with MPs containing NRG1, FGF1 or non-loaded MPs delivered via clinically-translatable percutaneous transendocardial-injection. Three months post-treatment, echocardiography indicated a significant improvement in systolic and diastolic cardiac function. Moreover, improvement in bipolar voltage and decrease in transmural infarct progression was demonstrated by electromechanical NOGA-mapping. Functional benefit was associated with an increase in myocardial vascularization and remodeling. These findings in a large animal model of ischemia-reperfusion demonstrate the feasibility and efficacy of using MPs as a delivery system for growth factors and provide strong evidence to move forward with clinical studies using therapeutic proteins combined with catheter-compatible biomaterials.

  19. Incidence of nosocomial hemodialysis-associated bloodstream infections at a county teaching hospital.

    Science.gov (United States)

    Gnass, Matías; Gielish, Caren; Acosta-Gnass, Silvia

    2014-02-01

    Infections are an important cause of morbidity and mortality in patients undergoing hemodialysis. Limited information is to be found regarding nosocomial hemodialysis-associated bloodstream infections (HABSI). We sought to determine the rate of nosocomial HABSI and its associated risk factors at Riverside County Regional Medical Center. Inpatients who received hemodialysis during 2011 and 2012 were included, and outcomes were recorded along with risk factors. Data was analyzed with SPSS Inc software. A total of 619 patients was included. Fourteen HABSI were detected, with a rate of 3.33/1,000 hemodialysis sessions and 1.03/1,000 patient-days. An association was detected between HABSI and vascular access type (highest risk with nontunneled catheters), length of hospital stay, number of hemodialysis sessions, and hemoglobin A1c level. A correlation was also noted between HABSI because of MRSA and colonization of nares with MRSA. A predominance of staphylococci infections was detected. The rate of HABSI observed at Riverside County Regional Medical Center was lower than similar studies (2.5 per 1,000 patient-days and 3.95 per 1,000 hemodialysis sessions). The most important risk factors were determined to be nontunneled catheters, hemoglobin A1c greater than 7%, and nares colonization for HABSI because of MRSA. Infection prevention efforts in the inpatient hemodialysis population should focus on control of hyperglycemia and decolonization of nares from MRSA. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Electrifying catheters with light.

    Science.gov (United States)

    Pekař, Martin; van Rens, Jeannet; van der Mark, Martin B

    2017-04-17

    Smart minimally invasive devices face a connectivity challenge. An example is found in intracardiac echocardiography where the signal transmission and supply of power at the distal end require many thin and fragile wires in order to keep the catheter slim and flexible. We have built a fully functional bench-top prototype to demonstrate that electrical wires may be replaced by optical fibers. The prototype is immediately scalable to catheter dimensions. The absence of conductors will provide intrinsic galvanic isolation as well as radio frequency (RF) and magnetic resonance imaging (MRI) compatibility. Using optical fibers, we show signal transfer of synthetic aperture ultrasound images as well as photo-voltaic conversion to supply all electronics. The simple design utilizes only off the shelf components and holds a promise of cost effectiveness which may be pivotal for translation of these advanced devices into the clinic.

  1. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

    Energy Technology Data Exchange (ETDEWEB)

    Arabi, Mohammad, E-mail: marabi2004@hotmail.com; Ahmed, Ishtiaq; Mat’hami, Abdulaziz [Prince Sultan Military Medical City (PSMMC), Division of Endovascular Interventional Radiology, Department of Medical Imaging (Saudi Arabia); Ahmed, Dildar; Aslam, Naveed [Prince Sultan Military Medical City (PSMMC), Department of Nephrology (Saudi Arabia)

    2016-06-15

    PurposeWe report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.Materials and MethodsSince January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.ResultsTechnical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.ConclusionSharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.

  2. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

    Bjarnason, N H; Munkner, R; Kampmann, J P

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario...... estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations...... in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated...

  3. Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis.

    Science.gov (United States)

    Johansen, Kirsten L; Dalrymple, Lorien S; Glidden, David; Delgado, Cynthia; Kaysen, George A; Grimes, Barbara; Chertow, Glenn M

    2016-04-07

    Frailty is common among patients on dialysis and increases vulnerability to dependency and death. We examined the predictive ability of frailty on the basis of physical performance and self-reported function in participants of a US Renal Data System special study that enrolled a convenience sample of 771 prevalent patients on hemodialysis from 14 facilities in the Atlanta and northern California areas from 2009 to 2011. Performance-based frailty was assessed using direct measures of grip strength (weakness) and gait speed along with weight loss, exhaustion, and low physical activity; poor self-reported function was substituted for weakness and slow gait speed in the self-reported function-based definition. For both definitions, patients meeting three or more criteria were considered frail. The mean age of 762 patients included in analyses was 57.1±14.2 years old; 240 patients (31%) met the physical performance-based definition of frailty, and 396 (52%) met the self-reported function-based definition. There were 106 deaths during 1.7 (interquartile range, 1.4-2.4) years of follow-up. After adjusting for demographic and clinical characteristics, the hazard ratio (HR) for mortality for the performance-based definition (2.16; 95% confidence interval [95% CI], 1.41 to 3.29) was slightly higher than that of the self-reported function-based definition (HR, 1.93; 95% CI, 1.24 to 3.00). Patients who met the self-report-based definition but not the physical performance definition of frailty (n=192) were not at statistically significantly higher risk of mortality than those who were not frail by either definition (n=330; HR, 1.41; 95% CI, 0.81 to 2.45), but those who met both definitions of frailty (n=204) were at significantly higher risk (HR, 2.46; 95% CI, 1.51 to 4.01). Frailty, defined using either direct tests of physical performance or self-reported physical function, was associated with higher mortality among patients receiving hemodialysis. Future studies are needed

  4. Catheter-deliverable hydrogel derived from decellularized ventricular extracellular matrix increases endogenous cardiomyocytes and preserves cardiac function post-myocardial infarction

    Science.gov (United States)

    Singelyn, Jennifer M.; Sundaramurthy, Priya; Johnson, Todd D.; Schup-Magoffin, Pamela J.; Hu, Diane P.; Faulk, Denver M.; Wang, Jean; Mayle, Kristine M.; Bartels, Kendra; Salvatore, Michael; Kinsey, Adam M.; DeMaria, Anthony N.; Dib, Nabil; Christman, Karen L.

    2012-01-01

    Objectives This study evaluated the use of an injectable hydrogel derived from ventricular extracellular matrix (ECM) for treating myocardial infarction (MI) and its ability to be delivered percutaneously. Background Injectable materials offer promising alternatives to treat MI. While most of the examined materials have shown preserved or improved cardiac function in small animal models, none have been specifically designed for the heart and few have translated to catheter delivery in large animal models. Methods We have developed a myocardial specific hydrogel, derived from decellularized ventricular ECM, which self-assembles when injected in vivo. Female Sprague-Dawley rats underwent ischemia reperfusion followed by injection of the hydrogel or saline 2 weeks later. The implantation response was assessed via histology and immunohistochemistry, and potential for arrhythmogenesis was examined using programmed electrical stimulation 1 week post-injection. Cardiac function was analyzed with magnetic resonance imaging 1 week pre-injection and 4 weeks post-MI. In a porcine model, we delivered the hydrogel using the NOGA guided Myostar catheter, and utilized histology to assess retention of the material. Results We demonstrate that injection of the material in the rat MI model increases endogenous cardiomyocytes in the infarct area and maintains cardiac function without inducing arrhythmias. Furthermore, we demonstrate feasibility of transendocardial catheter injection in a porcine model. Conclusion To our knowledge, this is the first in situ gelling material to be delivered via transendocardial injection in a large animal model, a critical step towards the translation of injectable materials for treating myocardial infarction in humans. Our results warrant further study of this material in a large animal model of myocardial infarction and suggest this may be a promising new therapy for treating myocardial infarction. PMID:22340268

  5. Respiration and heartbeat signal detection from airflow at airway in rat by catheter flow sensor with temperature compensation function

    Science.gov (United States)

    Hasegawa, Y.; Kawaoka, H.; Yamada, T.; Matsushima, M.; Kawabe, T.; Shikida, M.

    2017-12-01

    We previously proposed an evaluation method for detecting both respiration and heartbeat signals from the airflow at the mouth (Kawaoka et al 201518th Int. Conf. on Solid-State Sensors, Actuators and Microsystems; Kawaoka et al 2015 IEEE Sensors; Kawaoka et al 2016 Technical Digest IEEE Micro Electro Mechanical Systems Conf.). In the current study, we developed a catheter flow sensor with temperature compensation that uses MEMS technologies and used it to directly detect the breathing airflow in the airway of a rat. The temperature sensors were integrated with the catheter flow sensor. Heaters working as airflow and temperature sensors were produced on polymer film by using the same fabrication process so that the temperature coefficients of their resistances would coincide. As a result, the variation in sensor outputs due to the airflow temperature changes ranging from 20 °C to 34 °C was suppressed to less than 2.5%. The developed catheter flow sensor was inserted into the airway of a rat to detect both respiration and heartbeat signals. The accuracy of the breathing airflow measurements was improved thanks to the temperature compensation. The tidal volume variations between the expired and inspired air were suppressed to within 5%. Heartbeat signal information was extracted from the measured breathing waveforms by applying a discrete Fourier transform.

  6. Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure

    Energy Technology Data Exchange (ETDEWEB)

    Bergey, E.A.; Kaye, R.D.; Reyes, J.; Towbin, R.B. [Department of Radiology, Children`s Hospital of Pittsburgh, PA (United States)

    1999-01-01

    Introduction. Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins. Materials and methods. Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred. Discussion. Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage. Conclusion. Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins. (orig.) With 2 figs., 7 refs.

  7. The ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em) predicts improvement in left ventricular systolic and diastolic function 1 year after catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Kim, In-Soo; Kim, Tae-Hoon; Shim, Chi-Young; Mun, Hee-Sun; Uhm, Jae Sun; Joung, Boyoung; Hong, Geu-Ru; Lee, Moon-Hyoung; Pak, Hui-Nam

    2015-07-01

    Successful rhythm control after atrial fibrillation catheter ablation is known to induce left atrial reverse remodelling and improve left ventricular (LV) function. We explored the clinical factors affecting LV systolic and diastolic function 1-year after catheter ablation for atrial fibrillation. We compared pre-procedural and 1-year follow-up echocardiograms in 521 patients with atrial fibrillation who underwent catheter ablation. Left ventricular systolic function was estimated by the ejection fraction (EF); diastolic function was estimated by the ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em). (i) Catheter ablation of atrial fibrillation significantly reduced left atrium volume index (P Em Em was significantly reduced in patients with pre-procedural E/Em ≥ 15 (n = 67, P = 0.008). (iii) Baseline E/Em Em ≥ 15 (β = 4.896, 95% CI 3.45 to 6.34, P Em. Pre-procedural E/Em predicted improvement in LV systolic and diastolic functions 1 year after catheter ablation for atrial fibrillation. Low baseline E/Em was independently associated with improved EF, while high E/Em predicted improvement in LV diastolic function. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  8. Renal function and risk of stroke and bleeding in patients undergoing catheter ablation for atrial fibrillation: Comparison between uninterrupted direct oral anticoagulants and warfarin administration.

    Science.gov (United States)

    Yanagisawa, Satoshi; Inden, Yasuya; Fujii, Aya; Ando, Monami; Funabiki, Junya; Murase, Yosuke; Takenaka, Masaki; Otake, Noriaki; Ikai, Yoshihiro; Sakamoto, Yusuke; Shibata, Rei; Murohara, Toyoaki

    2018-03-01

    The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood. The present study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with those of uninterrupted warfarin use in patients undergoing catheter ablation for AF stratified by various renal function groups. A total of 2091 patients were retrospectively included in this study. The study population was divided into 4 groups: creatinine clearance level ≥80 mL/min (n = 1086), 50-79 mL/min (n = 774), 15-49 mL/min (n = 209), and <15 mL/min (n = 22). We investigated periprocedural complications and compared them between uninterrupted DOAC and warfarin groups. There was no significant difference in thromboembolic events among the 4 groups (0.6%, 0.6%, 1.0%, and 0%, respectively; P = .792). However, major bleeding events (0.9%, 1.4%, 4.8%, and 4.5%; P < .001) and minor bleeding events (4.1%, 6.1%, 11.5%, and 13.6%; P < .001) primarily occurred in patients with CKD. The rate of periprocedural complications in the DOAC group was similar to that in the warfarin group for each renal function category. Adverse events did not differ after adjustment using propensity score-matched analysis. Multivariate analysis showed that lower body weight, antiplatelet drug use, initial ablation session, and CKD were independent predictors of adverse events. The periprocedural bleeding risk was increased in patients with CKD. Uninterrupted DOAC and warfarin administration during catheter ablation for AF in patients with CKD is feasible and effective. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  9. Impact of Additional Transthoracic Electrical Cardioversion on Cardiac Function and Atrial Fibrillation Recurrence in Patients with Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation

    Directory of Open Access Journals (Sweden)

    Deguo Wang

    2016-01-01

    Full Text Available Backgrounds and Objective. During the procession of radiofrequency catheter ablation (RFCA in persistent atrial fibrillation (AF, transthoracic electrical cardioversion (ECV is required to terminate AF. The purpose of this study was to determine the impact of additional ECV on cardiac function and recurrence of AF. Methods and Results. Persistent AF patients received extensive encircling pulmonary vein isolation (PVI and additional line ablation. Patients were divided into two groups based on whether they need transthoracic electrical cardioversion to terminate AF: electrical cardioversion (ECV group and nonelectrical cardioversion (NECV group. Among 111 subjects, 35 patients were returned to sinus rhythm after ablation by ECV (ECV group and 76 patients had AF termination after the ablation processions (NECV group. During the 12-month follow-ups, the recurrence ratio of patients was comparable in ECV group (15/35 and NECV group (34/76 (44.14% versus 44.74%, P=0.853. Although left atrial diameters (LAD decreased significantly in both groups, there were no significant differences in LAD and left ventricular cardiac function between ECV group and NECV group. Conclusions. This study revealed that ECV has no significant impact on the maintenance of SR and the recovery of cardiac function. Therefore, ECV could be applied safely to recover SR during the procedure of catheter ablation of persistent atrial fibrillation.

  10. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    Directory of Open Access Journals (Sweden)

    R. Zea-Vera

    2016-01-01

    Full Text Available Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.

  11. Safety of gadolinium contrast agent in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Okada, S. [Nippon Medical School, Chiba-Hokuso Hospital (Japan). Dept. of Radiology; Katagiri, K.; Kumazaki, T. [Nippon Medical School, Tokyo (Japan). Dept. of Radiology; Yokoyama, H. [Ishinkai Clinic, Chiba (Japan). Dept. of Urology

    2001-05-01

    Purpose: We evaluated the safety of a gadolinium (Gd) contrast agent in hemodialysis patients. Material and Methods: Seventy hemodialysis patients underwent contrast-enhanced MR examination. After the examination, the patients were hemodialyzed on a usual schedule, i.e., 3 times per week at 4 h each session. The hemodialysis was performed on the same day in 16 patients, the next day in 34, 2 days later in 14 and 3 days later in 6 patients. Serum Gd concentrations before and after the first to fourth hemodialysis sessions were analyzed in 11 patients. Cardiovascular, cutaneous, respiratory, psycho-neurological and digestive side effects were evaluated in all patients. Changes in liver and kidney functions, blood counts, and electrolytes were also checked. Results and Conclusion: Neither side effects nor blood changes were noted in any of the patients. Average excretory rates were 78.2%, 95.6%, 98.7% and 99.5% in the first to fourth hemodialysis sessions, respectively. These results suggest that Gd contrast agents can be used in hemodialysis patients if hemodialysis is carried out promptly after the examination. Key words: Renal failure, hemodialysis; contrast agent, gadolinium.

  12. Hemodialysis access -- self care

    Science.gov (United States)

    ... hemodialysis. Taking good care of your access helps make it last longer. Prevent Infection in Your Access Keep your access clean. Wash the access with soap and water every day to decrease your risk of infection. ...

  13. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  14. Endovascular Proximal Forearm Arteriovenous Fistula for Hemodialysis Access: Results of the Prospective, Multicenter Novel Endovascular Access Trial (NEAT).

    Science.gov (United States)

    Lok, Charmaine E; Rajan, Dheeraj K; Clement, Jason; Kiaii, Mercedeh; Sidhu, Ravi; Thomson, Ken; Buldo, George; Dipchand, Christine; Moist, Louise; Sasal, Joanna

    2017-10-01

    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. Prospective, single-arm, multicenter study (Novel Endovascular Access Trial [NEAT]). Consecutive adult non-dialysis-dependent and dialysis-dependent patients referred for vascular access creation at 9 centers in Canada, Australia, and New Zealand. Using catheter-based endovascular technology and radiofrequency energy, an anastomosis was created between target vessels, resulting in an endovascular AVF (endoAVF). Safety, efficacy, functional usability, and patency end points. Safety as percentage of device-related serious adverse events; efficacy as percentage of endoAVFs physiologically suitable (brachial artery flow ≥ 500mL/min, vein diameter ≥ 4mm) for dialysis within 3 months; functional usability of endoAVFs to provide prescribed dialysis via 2-needle cannulation; primary and cumulative endoAVF patencies per standardized definitions. 80 patients were enrolled (20 roll-in and 60 participants in the full analysis set; the latter are reported). EndoAVFs were created in 98% of participants; 8% had a serious procedure-related adverse event (2% device related). 87% were physiologically suitable for dialysis (eg, mean brachial artery flow, 918mL/min; endoAVF vein diameter, 5.2mm [cephalic vein]). EndoAVF functional usability was 64% in participants who received dialysis. 12-month primary and cumulative patencies were 69% and 84%, respectively. Due to the unique anatomy and vessels used to create endoAVFs, this was a single-arm study without a surgical comparator. An endoAVF can be reliably created using a radiofrequency magnetic catheter-based system, without open surgery and with minimal complications. The endoAVF can be successfully used for hemodialysis and demonstrated high 12-month

  15. Central venous catheter - flushing

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000157.htm Central venous catheter - flushing To use the sharing features on this page, please enable JavaScript. You have a central venous catheter. This is a tube that goes into a ...

  16. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience.

    Science.gov (United States)

    Rus, Rina R; Premru, Vladimir; Novljan, Gregor; Grošelj-Grenc, Mojca; Ponikvar, Rafael

    2016-06-01

    Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  17. Blood Oxygenation Level-Dependent Functional MRI of Early Evidences of Brain Plasticity after Hemodialysis Session by Helixone Membrane of Patients with Indices of Adrenal Deficiency.

    Science.gov (United States)

    Boujraf, Saïd; Belaïch, Rachida; Housni, Abdelkhalek; Maaroufi, Mustapha; Tizniti, Siham; Sqalli, Tarik; Benzagmout, Mohammed

    2017-05-01

    Various alterations of hypothalamic-pituitary-adrenal axis function have been described in patients with chronic renal failure. Nevertheless, controversial evidences were stated about the association between adrenal function deficiency (AD) and hemodialysis (HD). The goal of this paper was to estimate indirect indices of the adrenal gland dysfunction which is potentially influenced by oxidative stress (OS) that still generates brain plasticity and reorganization of the functional control. Two male patients undergoing HD by the synthetic Helixone membrane for more than 6 months at the HD Center of the University Hospital of Fez, Fez, Morocco, were recruited. They underwent identical assessment immediately before and after the full HD session; this consisted of a blood ionogram revealing rates of sodium and calcium, and brain blood oxygenation level-dependent functional MRI (BOLD-fMRI) using a motor paradigm in block design. The blood ionogram revealed hypercalcemia and hyponatremia in both patients. Both biological assessment and BOLD-fMRI study results revealed a high level of OS that induced activation of a significantly large brain volume area suggesting the occurrence of possible brain plasticity and functional control reorganization induced by free radicals and enhanced by AD. The occurrence of brain plasticity and functional control reorganization was demonstrated in both patients studied who were undergoing HD by BOLD-fMRI with a notable sensitivity; this plasticity is induced by elevated OS occasioned by HD technique itself and probably amplified by AD. Similar results were found in a previous study performed on the same patients undergoing HD by a polysulfone membrane.

  18. The impact of volume overload on right heart function in end-stage renal disease patients on hemodialysis.

    Science.gov (United States)

    Ünlü, Serkan; Şahinarslan, Asife; Gökalp, Gökhan; Seçkin, Özden; Arınsoy, Selim Turgay; Boyacı, Nuri Bülent; Çengel, Atiye

    2017-12-11

    The aim of this study was to evaluate the impact of volume overload on echocardiographic parameters used for the assessment of the right ventricle (RV) and right atrium (RA), to determine volume-independent parameters and to noninvasively investigate the physio-mechanics of RV and RA by examining end-stage kidney patients before and after hemodialysis (HD). The echocardiographic images were obtained from 67 patients (49.2 ± 17.3 years, 23 f) before and after HD. Changes in echocardiographic parameters with HD were examined. The average ultrafiltrated volume was 3088.1 ± 1103.7 mL. The size of RV and RA and tricuspid annular plane systolic excursion (TAPSE) decreased after HD, whereas myocardial performance index increased. RV fractional area change and iso-volumetric contraction acceleration time remained unchanged. RV global longitudinal strain (GLS) and RV early diastolic strain rate (SR) decreased after HD. Systolic and late diastolic SR of the RV showed no statistically significant difference after HD. Longitudinal strain and SR of RA contraction were not significantly different after HD. The changes in RV GLS (r = .641, P = .027), RV free wall longitudinal strain (r = .643, P information on RA physio-mechanics. This might lead to a better evaluation of the cardiac pathophysiology and hemodynamics of patients. Moreover, providing novel volume-independent parameters for the evaluation of right heart chambers would improve the clinical perspectives of patients. © 2017, Wiley Periodicals, Inc.

  19. [Update on proteomic use in hemodialysis].

    Science.gov (United States)

    Bonomini, Mario; Sirolli, Vittorio; Baroni, Silvia; Urbani, Andrea

    2017-08-01

    Application of proteomics has become one of the leading experimental disciplines for increased understanding of the key role played by proteins and protein-protein interactions in all aspects of cell function. There is an increasing use of proteomic technologies for investigation into renal replacement therapy such as hemodialysis. In the last 10 years, the application of shotgun bottom-up liquid chromatography-mass spectrometry/mass spectrometry approaches has been successfully applied to research in uremic toxicity, with the discovery of novel uremic toxins and the potential to delineate a precise molecular approach to defining the biochemical nature of uremia. Major investigations of proteomics in hemodialysis therapy include molecular definition of uremic toxicity, identification of prognostic biomarkers, blood purification efficiency testing, and biocompatibility assessment of the dialyzer membrane materials. In this article, we review the results of recent proteoic investigations in the setting of chronic hemodialysis therapy. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

  20. Central vein perforation during tunneled dialysis catheter insertion: principles of acute management.

    Science.gov (United States)

    Pua, Uei

    2014-10-01

    Central venous perforation during dialysis catheter insertion is a potentially fatal complication. Prompt recognition and judicious initial steps are important in optimizing the outcome. The purpose of this manuscript is to illustrate the imaging features and steps in initial management. © 2014 International Society for Hemodialysis.

  1. Copeptin in Hemodialysis Patients with Left Ventricular Dysfunction.

    Science.gov (United States)

    Kim, Jae Seok; Yang, Jae Won; Chai, Moon Hee; Lee, Jun Young; Park, Hyeoncheol; Kim, Youngsub; Choi, Seung Ok; Han, Byoung Geun

    2015-07-01

    Copeptin has been considered as a useful marker for diagnosis and prediction of prognosis in heart diseases. However, copeptin has not been investigated sufficiently in hemodialysis patients. This study aimed to investigate the general features of copeptin in hemodialysis and to examine the usefulness of copeptin in hemodialysis patients with left ventricular dysfunction (LV dysfunction). This study included 41 patients on regular hemodialysis. Routine laboratory data and peptides such as the N-terminal of the prohormone brain natriuretic peptide and copeptin were measured on the day of hemodialysis. Body fluid volume was estimated by bioimpedance spectroscopy, and the E/Ea ratio was estimated by echocardiography. Copeptin increased to 171.4 pg/mL before hemodialysis. The copeptin had a positive correlation with pre-dialysis body fluid volume (r=0.314; p=0.04). The copeptin level decreased along with body fluid volume and plasma osmolality during hemodialysis. The copeptin increased in the patients with LV dysfunction more than in those with normal LV function (218.7 pg/mL vs. 77.6 pg/mL; p=0.01). Receiver operating characteristic curve analysis showed that copeptin had a diagnostic value in the hemodialysis patients with LV dysfunction (area under curve 0.737; p=0.02) and that the cut-off value was 125.48 pg/mL (sensitivity 0.7, specificity 0.8, positive predictive value 0.9, negative predictive value 0.6). Copeptin increases in hemodialysis patients and is higher in patients with LV dysfunction. We believe that copeptin can be a useful marker for the diagnosis of LV dysfunction in hemodialysis patients.

  2. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in

  3. Functional polymorphisms in matrix metalloproteinases-1, -3, -9 are associated with arteriovenous fistula patency in hemodialysis patients.

    Science.gov (United States)

    Lin, Chih-Ching; Yang, Wu-Chang; Chung, Ming-Yi; Lee, Pui-Ching

    2010-10-01

    Matrix metalloproteinases (MMPs) are risk factors for cardiovascular diseases. This study evaluated the association of genotype polymorphisms of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in hemodialysis (HD) patients with arteriovenous fistula (AVF) failure. Genotype polymorphism of MMP-1, MMP-2, MMP-3, and MMP-9 and TIMP-1 and TIMP-2 and clinical and laboratory parameters were compared between Chinese HD patients with (n = 170) and without (n = 426) AVF failure. Significant associations were found between AVF failure and the following factors (hazard ratio): longer HD duration (1.007 per month), lower pump flow (0.991 per ml/min), higher dynamic venous pressure (1.016 per mmHg), location of AVF on right side (1.630 versus left side) and upper arm (2.385 versus forearm), history of cardiovascular disease (1.656 versus absence of history), 1G/1G genotype of MMP-1 -1607 1G >2G SNP (2.315 versus 1G/2G + 2G/2G genotypes), 6A/6A genotype of MMP-3 -1612 5A >6A SNP (1.712 versus 5A/6A + 5A/5A), and C/C genotype of MMP-9 -1562 C>T SNP (1.650 versus C/T+T/T). The positive predictive rates for AVF failure were 63.0% and 6.7% for patients with the highest-risk (1G1G/6A6A/CC) and lowest-risk (2G2G or 2G1G/5A5A or 6A6A/TT or TC) composite MMP-1/MMP-3/MMP-9 genotype, respectively. The unassisted patency of AVF at 5 years decreased significantly from 93.3% to 38.4% for the composite MMP-1/MMP-3/MMP-9 genotypes (lowest versus highest risk, P < 0.001). Specific genotypes of MMP-1, MMP-3 and MMP-9 with lower transcriptional activity are associated with higher frequencies of AVF failure, which may result from more accumulation of extracellular matrix, leading to AVF stenosis.

  4. Silicone and polyurethane tunneled infusion catheters: a comparison of durability and breakage rates.

    Science.gov (United States)

    Cohen, Aaron B; Dagli, Mandeep; Stavropoulos, S William; Mondschein, Jeffrey I; Soulen, Michael C; Shlansky-Goldberg, Richard D; Solomon, Jeffrey A; Chittams, Jesse L; Trerotola, Scott O

    2011-05-01

    To examine the overall durability and breakage rates of dual-lumen silicone catheters in comparison with power-injectable dual-lumen polyurethane catheters. Patients who received a 10-F dual-lumen silicone catheter or 9.5-F dual-lumen polyurethane catheter between January 2002 and July 2009 were identified through a quality assurance database. Medical records were reviewed retrospectively. A total of 117 silicone and 94 polyurethane catheters were identified in 192 patients. Reasons for catheter placement and removal were recorded, as were cases of breakage and repairs. Catheter durability was compared; survival analysis was also performed. Breakage occurred in nine of 117 silicone catheters (8%) and none of 94 polyurethane catheters (P = .005). Most catheters were placed for malignancy (162 of 211; 77%); nonmalignant indications such as total parenteral nutrition accounted for 49 out of 211 catheters (23%). The mean silicone catheter dwell time was 99 days (11,612 total catheter-days), and the mean polyurethane catheter dwell time was 78 days (7,362 total catheter-days). There was no significant difference in overall duration of function (ie, survival) between silicone and polyurethane catheters (P = .12). The infection rates were 3.6 per 1,000 catheter-days for silicone catheters and 3.5 per 1,000 catheter-days for polyurethane catheters (P value not significant). There were fewer catheter fractures with the polyurethane catheter compared with the silicone catheter, although there was no difference in the total access site service interval for the two catheter types. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  5. Catheter Angiography

    Medline Plus

    Full Text Available ... operate to reopen the vessel. If you have diabetes or kidney disease, the kidneys may be injured ... impaired kidney function, especially those who also have diabetes, are not good candidates for this procedure. Patients ...

  6. Infrequent Dialysis: A New Paradigm for Hemodialysis Initiation

    Science.gov (United States)

    Rhee, Connie M.; Unruh, Mark; Chen, Jing; Kovesdy, Csaba P.; Zager, Phillip; Kalantar-Zadeh, Kamyar

    2013-01-01

    Nearly a half-century ago, the thrice-weekly hemodialysis schedule was empirically established as a means to provide an adequate dialysis dose while also treating the greatest number of end-stage renal disease patients using limited resources. Landmark trials of hemodialysis adequacy have historically been anchored to thrice-weekly regimens, but a recent randomized controlled trial demonstrated that frequent hemodialysis (six times per week) confers cardiovascular and survival benefits. Based on these collective data and experience, clinical practice guidelines advise against a less than thrice-weekly treatment schedule in patients without residual renal function, yet provide limited guidance on the optimal treatment frequency when substantial native kidney function is present. Thus, during the transition from Stage 5 chronic kidney disease to end-stage renal disease, the current paradigm is to initiate hemodialysis on a “full dose” thrice-weekly regimen even among patients with substantial residual renal function. However, emerging data suggests that frequent hemodialysis accelerates residual renal function decline, and infrequent regimens may provide better preservation of native kidney function. Given the high mortality rates during the first 90 days of hemodialysis and the survival benefits of preserved native kidney function, initiation with twice-weekly treatment schedules (“infrequent hemodialysis”) with an incremental increase in frequency over time may provide an opportunity to optimize patient survival. This review outlines the clinical benefits of post-hemodialysis residual renal function, studies of twice-weekly treatment regimens, and the potential risks and benefits of infrequent hemodialysis. PMID:24016197

  7. The home hemodialysis hub: physical infrastructure and integrated governance structure.

    Science.gov (United States)

    Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M

    2015-04-01

    An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.

  8. Hemodialysis removal of norfloxacin.

    Science.gov (United States)

    Lau, A H; Tang, I; Fitzloff, J; Jain, R

    1994-01-01

    The effect of hemodialysis on norfloxacin removal was evaluated in 7 patients. Single 800-mg doses of the drug were given to the subjects prior to dialysis using cuprophan hollow fiber dialyzers. Arterial and venous sample pairs were obtained at hourly intervals during treatment. Norfloxacin plasma concentrations were determined by HPLC. The mean hemodialysis clearance and extraction ratio were 38.84 +/- 10.92 ml/min and 0.19 +/- 0.06, respectively. Small differences in these parameters were observed between dialyzers with different surface areas (p > 0.05) and also between treatments using different blood flow rates (p > 0.05). Since a relatively small amount of norfloxacin is removed by hemodialysis, dosage adjustment is not necessary to compensate for the extracorporeal removal.

  9. Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management.

    Science.gov (United States)

    Rhee, Connie M; Ghahremani-Ghajar, Mehrdad; Obi, Yoshitsugu; Kalantar-Zadeh, Kamyar

    2017-06-01

    Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.

  10. The role of intraoperative hemodialysis in liver transplant patients.

    Science.gov (United States)

    Sedra, Ashraf H; Strum, Earl

    2011-06-01

    Orthotopic liver transplant (OLT) is a major surgical procedure that can be both challenging and lengthy. One of the common findings in end-stage liver disease is renal failure, whether acute or chronic, which may complicate the intraoperative course. The use of intraoperative hemodialysis is described by several centers to aid during OLT cases with impaired renal function or kidney failure. Unfortunately, there is a paucity of available data, which is limited to sporadic case reports, and only few structured studies in which continuous renal replacement therapy was used versus intraoperative hemodialysis, which is the main focus of this article. The rationale behind the use of intraoperative hemodialysis during OLT in patients with kidney dysfunction or failure is that the procedure is usually complicated by major hemodynamic changes, metabolic derangement, and coagulation abnormalities, which we think can be better managed intraoperatively using hemodialysis. In our institution, we performed over 140 cases of OLT using intraoperative hemodialysis since 2003 until the present. A retrospective cohort study is being conducted during the writing of this article. Preliminary data collection report zero percentage intraoperative mortality and 48 h postoperatively. Hemodialysis is widely acknowledged as a treatment option to stabilize patients with renal failure, and one of the most challenging situations is during OLT in which the role of intraoperative hemodialysis is becoming more important today more than ever before.

  11. Inpatient citrate-based hemodialysis in pediatric patients.

    Science.gov (United States)

    Fajardo, Cecile; Sanchez, Cheryl P; Cutler, Drew; Sahney, Shobha; Sheth, Rita

    2016-10-01

    Citrate-based dialysate is an effective method of hemodialysis (HD) anticoagulation in adults. The objective of this study was to evaluate this therapy as an alternative to heparin anticoagulation in pediatric patients in the inpatient setting requiring HD. We performed a prospective, non-randomized study of citrate-based dialysate HD treatments (N = 119) over a 9-month period in 18 pediatric patients (age range 0-18 years) admitted to hospital. Primary outcome measures were thrombosis incidence rates that resulted in circuit loss, catheter loss or early dialysis termination. Secondary outcome measures were hypocalcemia incidence and heparin use. Data analysis was performed using descriptive and comparative statistics. There was a thrombosis incidence rate of 2.5 % circuit loss, 2.5 % catheter loss and 5.9 % early dialysis termination due to the thrombosis risk. In 64 % of treatments a circuit clot developed but with no circuit loss, and mild asymptomatic hypocalcemia deveoped in 58 % of the monitored HD sessions . No patient required additional heparin during the citrate-based HD treatments, but 11.1 % were subsequently converted to heparin anticoagulation. Our study showed a low percentage of thrombotic episodes resulting in catheter or circuit loss. Hypocalcemia was common but remained mild and asymptomatic. Citrate-based dialysate was well tolerated by our patients. We therefore conclude that citrate-based dialysate is a safe alternative to heparin-based hemodialysis anticoagulation.

  12. Carnitine in maintenance hemodialysis patients.

    Science.gov (United States)

    Guarnieri, Gianfranco

    2015-03-01

    Carnitine is a conditionally essential metabolite that plays a critical role in cell physiology. Carnitine is necessary for fatty acid transport to sites of beta-oxidation in the mitochondria, where it also helps to prevent organic acid accumulation. Because of these key regulatory functions, carnitine represents a crucial determinant of mitochondrial energy metabolism, whose deficiency may lead to metabolic and clinical disturbances. Loss of carnitine through dialytic membranes occurs in maintenance hemodialysis, resulting in potential carnitine depletion and relative increments of esterified carnitine forms. Carnitine supplementation has been reported to counteract some of these alterations and has been associated with some clinical benefits, such as enhanced response to erythropoietin as well as improvement in exercise tolerance, intradialytic symptom, hyperparathyroidism, insulin resistance, inflammatory and oxidant status, protein balance, lipid profile, cardiac function, and quality of life. Carnitine supplementation has an attractive theoretical rationale; however, there are no definitive supportive studies and conclusive evidence that L-carnitine supplementation in maintenance hemodialysis patients could improve these conditions. A trial of carnitine administration could be attempted for 6 to 12 months only in selected patients on dialysis who do not adequately respond to standard therapies, in the presence of symptomatology, and in conjunction with patient dialysis age and documented L-carnitine deficiency. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Modification of the HeRO Graft Allowing Earlier Cannulation and Reduction in Catheter Dependent Days in Patients with End Stage Renal Disease: A Single Center Retrospective Review

    Directory of Open Access Journals (Sweden)

    Deirdre Hart

    2014-01-01

    Full Text Available After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

  14. Modification of the HeRO graft allowing earlier cannulation and reduction in catheter dependent days in patients with end stage renal disease: a single center retrospective review.

    Science.gov (United States)

    Hart, Deirdre; Gooden, Christie; Cummings, L S; Wible, Brandt C; Borsa, John; Randall, Henry

    2014-01-01

    After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

  15. Plasma Beta-Trace Protein as a Marker of Residual Renal Function: The Effect of Different Hemodialysis Modalities and Intra-Individual Variability over Time

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    Amaryllis H. van Craenenbroeck

    2017-11-01

    Full Text Available Background/Aims: Beta-trace protein (BTP is a low-molecular-weight molecule, which may be used to assess residual renal function (RRF in dialysis patients. Here we evaluated the influence of hemodialysis (HD and hemodiafiltration (HDF on plasma BTP, and analyzed the inter- and intra-individual variability of plasma BTP over time in HD and peritoneal dialysis (PD patients. Methods: In 12 prevalent HD patients, the effect of a single session of low-flux HD, high-flux HD and HDF on plasma BTP was studied. Blood samples were taken at baseline, after 120 and 240 minutes, and at the start of the next dialysis session. In 13 HD patients and 10 PD patients, inter- and intra-individual variability over three months was studied (monthly and weekly, respectively. Plasma BTP was measured using a nephelometric method. Results: No significant decrease in plasma BTP was seen following a session of low-flux HD. Both high-flux HD and HDF resulted in a significant decrease immediately after dialysis (22% and 61% median decrease, respectively. A significant reduction of the molecule persisted only in HDF and a significant decrease (-15% was still found immediately before the start of the next dialysis session. In both HD and PD patients, the reproducibility over time was excellent with intra-class correlation coefficient of 0.96 (0.93-0.99 and 0.92 (0.86-0.99 respectively. In a small cohort of PD patients, fair agreement existed between mGFR (average of renal urea and creatinine clearance from a 24 hours urine collection and the BTP-based GFR estimation. Conclusion: BTP is a stable marker and a promising tool for RRF estimations in PD and HD patients. In patients receiving HDF, plasma levels of BTP should be interpreted with caution.

  16. Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study

    Science.gov (United States)

    Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A.; Stengel, Bénédicte

    2017-01-01

    Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32–1.56), diabetes (OR 1.28, 95% CI 1.15–1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09–1.49, and 1.31, 1.05–1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98–0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients’ comorbidity profiles may improve functional AV access rates. PMID:28749967

  17. Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study.

    Directory of Open Access Journals (Sweden)

    Natalia Alencar de Pinho

    Full Text Available Determinants of nonfunctional arteriovenous (AV access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR with 95% confidence intervals (CI of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32-1.56, diabetes (OR 1.28, 95% CI 1.15-1.44, and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09-1.49, and 1.31, 1.05-1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98-0.99 per 1% increase. The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients' comorbidity profiles may improve functional AV access rates.

  18. Small versus Large Catheters for Ventriculostomy in the Management of Intraventricular Hemorrhage.

    Science.gov (United States)

    Gilard, Vianney; Djoubairou, Ben Ousmanou; Lepetit, Arnaud; Metayer, Thomas; Gakuba, Clement; Gourio, Charlotte; Derey, Stephane; Proust, François; Emery, Evelyne; Gaberel, Thomas

    2017-01-01

    Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters. Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group. In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The metal ion-dependent adhesion site motif of the Enterococcus faecalis EbpA pilin mediates pilus function in catheter-associated urinary tract infection.

    Science.gov (United States)

    Nielsen, Hailyn V; Guiton, Pascale S; Kline, Kimberly A; Port, Gary C; Pinkner, Jerome S; Neiers, Fabrice; Normark, Staffan; Henriques-Normark, Birgitta; Caparon, Michael G; Hultgren, Scott J

    2012-01-01

    Though the bacterial opportunist Enterococcus faecalis causes a myriad of hospital-acquired infections (HAIs), including catheter-associated urinary tract infections (CAUTIs), little is known about the virulence mechanisms that it employs. However, the endocarditis- and biofilm-associated pilus (Ebp), a member of the sortase-assembled pilus family, was shown to play a role in a mouse model of E. faecalis ascending UTI. The Ebp pilus comprises the major EbpC shaft subunit and the EbpA and EbpB minor subunits. We investigated the biogenesis and function of Ebp pili in an experimental model of CAUTI using a panel of chromosomal pilin deletion mutants. A nonpiliated pilus knockout mutant (EbpABC(-) strain) was severely attenuated compared to its isogenic parent OG1RF in experimental CAUTI. In contrast, a nonpiliated ebpC deletion mutant (EbpC(-) strain) behaved similarly to OG1RF in vivo because it expressed EbpA and EbpB. Deletion of the minor pilin gene ebpA or ebpB perturbed pilus biogenesis and led to defects in experimental CAUTI. We discovered that the function of Ebp pili in vivo depended on a predicted metal ion-dependent adhesion site (MIDAS) motif in EbpA's von Willebrand factor A domain, a common protein domain among the tip subunits of sortase-assembled pili. Thus, this study identified the Ebp pilus as a virulence factor in E. faecalis CAUTI and also defined the molecular basis of this function, critical knowledge for the rational development of targeted therapeutics. Catheter-associated urinary tract infections (CAUTIs), one of the most common hospital-acquired infections (HAIs), present considerable treatment challenges for physicians. Inherently resistant to several classes of antibiotics and with a propensity to acquire vancomycin resistance, enterococci are particularly worrisome etiologic agents of CAUTI. A detailed understanding of the molecular basis of Enterococcus faecalis pathogenesis in CAUTI is necessary for the development of preventative and

  20. [Simulation in medicine: first experiences under hemodialysis].

    Science.gov (United States)

    Duranti, Ennio; Calzeroni, Gino; Venneri, Francesco; Marziali, Mauro

    2013-01-01

    Education and practical training in medicine is neglected and pass directly from theory to do on the field, while also each task requires the acquisition of health behaviors that are aware and accountable to the outreach. In hemodialysis is necessary to create synergies and partnerships between different cooperating figures. Addressing organizational and legal protection of the professionals (Clinical Risk). Acquiring operational capabilities of team work. Managing the team roles and functions.It is necessary then to acquire a modern methodology where the simulation represents the main tool, "the mistake" need to "learn" and the acquisition of "awareness" about event handling (in this case on Hemodialysis), in the context of clinical scenarios absolutely realistic.The methodology is based on simulated tasks using past experience as a business tool and innovative research. Debriefing and discussion with those involved and finally debrief collegiate looking for active/latent errors and use of international guidelines. Use of indicators to measure and review of performance during the various events and proactively promoting the reduction of the error.Among the types of participants was clear the minor presence of doctors of hemodialysis, probably for the wrong feeling of being checked and then judged in carrying out of actions made complex by urgency. In addition participating physicians have all stressed the usefulness of simulations of unusual events within the Hemodialysis treatment, but that if not solved can lead to death of the patient.Simulation under hemodialysis, although its first steps, appears to be an effective methodology able to stimulate self-criticism of the operators, but still with hesitations and fears above all by the nephrologists timorous of being judged more on technical skills than on organizational skills and leadership.

  1. Hemodialysis Key Features Mining and Patients Clustering Technologies

    Directory of Open Access Journals (Sweden)

    Tzu-Chuen Lu

    2012-01-01

    Full Text Available The kidneys are very vital organs. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease. To extend or save the lives of patients with impaired kidney function, kidney replacement is typically utilized, such as hemodialysis. This work uses an entropy function to identify key features related to hemodialysis. By identifying these key features, one can determine whether a patient requires hemodialysis. This work uses these key features as dimensions in cluster analysis. The key features can effectively determine whether a patient requires hemodialysis. The proposed data mining scheme finds association rules of each cluster. Hidden rules for causing any kidney disease can therefore be identified. The contributions and key points of this paper are as follows. (1 This paper finds some key features that can be used to predict the patient who may has high probability to perform hemodialysis. (2 The proposed scheme applies k-means clustering algorithm with the key features to category the patients. (3 A data mining technique is used to find the association rules from each cluster. (4 The mined rules can be used to determine whether a patient requires hemodialysis.

  2. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  3. Is residual renal function and better phosphate control in peritoneal dialysis an answer for the lower prevalence of valve calcification compared to hemodialysis patients?

    Science.gov (United States)

    Rroji, Merita; Seferi, Saimir; Cafka, Majlinda; Petrela, Elizana; Likaj, Erjola; Barbullushi, Myftar; Thereska, Nestor; Spasovski, Goce

    2014-01-01

    Cardiac valve calcification (CVC) has long been regarded as a consequence of abnormal calcium-phosphate metabolism in uremic patient associated with increased cardiovascular mortality in this population. We evaluated the association between residual renal function (RRF), phosphate level and valve calcification in peritoneal dialysis (PD) and hemodialysis (HD) patients. We studied 30 stable PD patients (60 % males; mean age 57 ± 12.36 years) and 34 HD patients (58.8 % males; mean age 50.8 ± 10.4 years) on renal replacement therapy (RRT) from 6 up to 36 months. The presence of CVC was assessed by standard bi-dimensional echocardiography. RRF was calculated by standard technique. Valve calcification was more frequently found in HD compared to PD patients (70.6 vs 29.4 %, p = 0.007). Significantly lower phosphate [1.38 ± 0.41 versus 1.99 ± 0.35 mmol/L (p < 0.0001)], a higher RRF [4.09 ± 2.09 ml/min vs 0.62 ± 0.89 ml/min (p < 0.0001)], and older age [57 ± 12.36 years vs 50.8 ± 10.4 years (p = 0.033)] were observed in PD as compared to HD patients. The logistic regression analysis for the presence of valve calcification when adjusted for age and diabetes, with type of therapy, serum phosphate, RRF, CRP, and serum albumin as variables in the model, revealed significant association between the presence of valve calcification and age and RRF. The correlation between phosphate levels and RRF was even stronger in PD patients than in HD patients (r = -0.704; p = 0.0001) vs (r = -0.502; p = 0.02). Our study shows that the residual renal function in PD patients contributes significantly to the maintenance of phosphate balance and may explain the lower prevalence of valve calcification in PD patients compared with HD patients in the period up to first 3 years under renal replacement therapy.

  4. Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

    Science.gov (United States)

    Lindsay, Robert M.; Cuerden, Meaghan S.; Garg, Amit X.; Port, Friedrich; Austin, Peter C.; Moist, Louise M.; Pierratos, Andreas; Chan, Christopher T.; Zimmerman, Deborah; Lockridge, Robert S.; Couchoud, Cécile; Chazot, Charles; Ofsthun, Norma; Levin, Adeera; Copland, Michael; Courtney, Mark; Steele, Andrew; McFarlane, Philip A.; Geary, Denis F.; Pauly, Robert P.; Komenda, Paul; Suri, Rita S.

    2012-01-01

    Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5–5.5 hours. Recently, the use of more intensive hemodialysis (>5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293 (21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 person-years; hazard ratio, 0.55 [95% confidence interval, 0.34–0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown. PMID:22362910

  5. Central venous catheter insertion problem solving using intravenous catheter: technical communication

    Directory of Open Access Journals (Sweden)

    Alemohammad M

    2013-02-01

    Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

  6. Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis

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    Kalyana C. Janga

    2017-01-01

    Full Text Available 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. CT scan of the chest, abdomen, and pelvis showed bilateral pleural effusions in the chest, with triangular opacities in the lungs suggestive of infarcts. There was splenomegaly with triangular hypodensities consistent with splenic infarcts. Blood cultures repeatedly grew Candida albicans. Despite parenteral antifungal therapy, the patient deteriorated over the course of 5 days. She died due to a subsequent cardiac arrest. Systemic review of literature revealed that the rate of infection varies amongst the various types of accesses, and it is well documented that AV fistulas have a much less rate of infection in comparison to temporary catheters. All dialysis units should strive to make a multidisciplinary effort to have a referral process early on, for access creation, and to avoid catheters associated morbidity.

  7. Portable calibration instrument of hemodialysis unit

    Science.gov (United States)

    Jin, Liang-bing; Li, Dong-sheng; Chen, Ai-jun

    2013-01-01

    For the purpose of meeting the rapid development of blood purification in China, improve the level of blood purification treatment, and get rid of the plight of the foreign technology monopolization to promise patients' medical safety, a parameter-calibrator for the hemodialysis unit, which can detect simultaneously multi-parameter, is designed. The instrument includes a loop, which connects to the hemodialysis unit. Sensors are in the loop in series, so that the dialysis can flow through this loop and the sensors can acquisitive data of various parameters. In order to facilitate detection and carrying, the integrated circuit part modularly based on the ultralow-power microcontrollers,TI MSP430 is designed. High-performance and small-packaged components are used to establish a modular, high-precision, multi-functional, portable system. The functions and the key technical indexes of the instrument have reached the level of products abroad.

  8. Relationships between post operative pain management and short term functional mobility in total knee arthroplasty patients with a femoral nerve catheter: A preliminary study

    Directory of Open Access Journals (Sweden)

    Ward Sarah

    2011-02-01

    Full Text Available Abstract Background Effective pain management following total knee arthroplasty (TKA is fundamental in achieving positive rehabilitation outcomes. The purpose of our study was to investigate post operative pain management in relation to short term functional mobility in an intervention group receiving concomitant use of an IV narcotic PCA and a continuous infusion of local anaesthetic via a femoral nerve catheter (CFNC, compared to a group receiving narcotic PCA alone. This was a preliminary study conducted to establish an appropriate design for a larger investigative study. Methods A prospective design was used to measure the effect of a CFNC on post operative pain management and functional mobility prior to hospital discharge. The amount of fentanyl used, pain and nausea scores, timed up and go (TUG tests and active range of knee movement (AROM were used to compare a CFNC and supplemental narcotic patient controlled analgesia (PCA group (n = 27 with a PCA only group (n = 25. Results The CFNC group used significantly less fentanyl than the PCA only group (p s = .505 p s = .529 p s = .328, p = .034 Conclusions In this small preliminary study improved TUG performance at Day 4 post op was not influenced by the use of a CFNC but was positively correlated with male gender, preoperative performance, time elapsed since last oral analgesia and pain score. However AROM was decreased in the CFNC group suggesting further research on the relationship between CFNCs, local anaesthetic concentration and quadriceps strength should be incorporated in the follow up study's design.

  9. Hemodialysis for Lactic Acidosis.

    Science.gov (United States)

    Karthiraj, N; Ramakrishnan, Nagarajan; Mani, Ashwin K

    2017-08-01

    Lactic acidosis (Type A) is common in critically ill patients and usually treated by correcting the underlying etiology. We present the case of a young female who presented with life-threatening lactic acidosis secondary to hematological malignancy. Timely initiation of hemodialysis was lifesaving. The case highlights the importance of considering Type B lactic acidosis (in this case secondary to a hematological malignancy) and also initiating renal replacement therapy when routine measures are ineffective.

  10. Hemodialysis for lactic acidosis

    OpenAIRE

    Karthiraj, N.; Nagarajan Ramakrishnan; Mani, Ashwin K.

    2017-01-01

    Lactic acidosis (Type A) is common in critically ill patients and usually treated by correcting the underlying etiology. We present the case of a young female who presented with life-threatening lactic acidosis secondary to hematological malignancy. Timely initiation of hemodialysis was lifesaving. The case highlights the importance of considering Type B lactic acidosis (in this case secondary to a hematological malignancy) and also initiating renal replacement therapy when routine measures a...

  11. Cloxacillin-induced seizure in a hemodialysis patient.

    Science.gov (United States)

    El Nekidy, Wasim; Dziamarski, Nicole; Soong, Derrick; Donaldson, Christine; Ibrahim, Muhieldean; Kadri, Albert

    2015-10-01

    We are reporting a cloxacillin-induced seizure in a patient with stage 5 chronic kidney disease requiring hemodialysis. To our knowledge, there are no published case reports of seizures induced by parenteral cloxacillin in hemodialysis patients. A young hemodialysis female was admitted to the hospital with decreased level of consciousness. Blood cultures revealed methicillin-sensitive Staphylococcus aureus where cloxacillin 2 g intravenously every 4 hours was initiated. Head computed tomography (CT) was not significant. After 14 hours of cloxacillin therapy (4 doses), the patient demonstrated tonic/clonic seizure activity, where phenytoin and lorazepam were initiated. The anti-seizure medications partially reduced seizure activity. Once the cloxacillin was discontinued, the seizures stopped. Two weeks later, all anti-seizure medications were stopped with no further seizure activity. Cloxacillin elimination in hemodialysis patients is similar to patients with normal kidney function. Although cloxacillin does not significantly cross the blood-brain barrier, the correlation between the start of seizures and cloxacillin initiation was confirmed by the negative CT and blood chemistry laboratory results. Moreover, seizure activity was terminated upon discontinuation of cloxacillin. Although further investigation for the cause of such seizures is warranted, clinicians should use caution when giving high doses of cloxacillin in hemodialysis patients. © 2015 International Society for Hemodialysis.

  12. A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein.

    Science.gov (United States)

    Wang, Pei; Wang, Yufei; Qiao, Yingjin; Zhou, Sijie; Liang, Xianhui; Liu, Zhangsuo

    2016-01-01

    Right internal jugular vein (IJV) is a preferred access route for tunneled (cuffed) dialysis catheters (TDCs), and both right external jugular vein (EJV) and left IJV are alternative routes for patients in case the right IJV isn't available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs. 49 hemodialysis patients who required TDCs through right EJV (n = 21) or left IJV (n = 28) as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI). A total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262-605) catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007). Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031). There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363-3.588; p = 0.001). Right EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.

  13. Fifty years of hemodialysis access literature: The fifty most cited publications in the medical literature.

    Science.gov (United States)

    Skripochnik, Edvard; O'Connor, David J; Trestman, Eric B; Lipsitz, Evan C; Scher, Larry A

    2018-02-01

    Objectives The modern era of hemodialysis access surgery began with the publication in 1966 by Brescia et al. describing the use of a surgically created arteriovenous fistula. Since then, the number of patients on chronic hemodialysis and the number of publications dealing with hemodialysis access have steadily increased. We have chronicled the increase in publications in the medical literature dealing with hemodialysis access by evaluating the characteristics of the 50 most cited articles. Methods We queried the Science Citation Index from the years 1960-2014. Articles were selected based on a subject search and were ranked according to the number of times they were cited in the medical literature. Results The 50 most frequently cited articles were selected for further analysis and the number of annual publications was tracked. The landmark publication by Dr Brescia et al. was unequivocally the most cited article dealing with hemodialysis access (1109 citations). The subject matter of the papers included AV fistula and graft (9), hemodialysis catheter (9), complications and outcomes (24), and other topics (8). Most articles were published in nephrology journals (33), with fewer in surgery (7), medicine (7), and radiology (3) journals. Of the 17 journals represented, Kidney International was the clear leader, publishing 18 articles. There has been an exponential rise in the frequency of publications regarding dialysis access with 42 of 50 analyzed papers being authored after 1990. Conclusion As the number of patients on hemodialysis has increased dramatically over the past five decades, there has been a commensurate increase in the overall number of publications related to hemodialysis access.

  14. Surface characterization of poly(vinyl chloride) urinary catheters functionalized with acrylic acid and poly(ethylene glycol) methacrylate using gamma-radiation

    Energy Technology Data Exchange (ETDEWEB)

    Islas, Luisa [Departamento de Química de Radiaciones y Radioquímica, Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico D.F. 04510 (Mexico); Ruiz, Juan-Carlos [División de Ciencias Básicas e Ingeniería, Depto. de Ingeniería de Procesos e Hidráulica, Universidad Autónoma Metropolitana-Iztapalapa, Av. San Rafael Atlixco No. 186, 09340 México D.F. (Mexico); Muñoz-Muñoz, Franklin [Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Carretera Transpeninsular Ensenada-Tijuana 3917, Ensenada, B.C. C.P 22860 (Mexico); Isoshima, Takashi [Nano Medical Engineering Laboratory, RIKEN, 2-1Hirosawa, Wako, Saitama 351-0198 (Japan); Burillo, Guillermina, E-mail: burillo@nucleares.unam.mx [Departamento de Química de Radiaciones y Radioquímica, Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico D.F. 04510 (Mexico)

    2016-10-30

    Highlights: • Polymer grafting using gamma-radiation allowed for acrylic acid and poly(ethylene glycol) methacrylate to graft on the inner and outer surface of poly(vinyl chloride) urinary catheters. • HR-XPS revealed the different compositional percentages of the compounds present on the surface of the catheter. • Catheters that were grafted with PEGMA had the roughest surface as observed using scanning electron microscopy (SEM) and confocal laser microscopy (CLM). - Abstract: Poly(vinyl chloride) (PVC) urinary catheters were modified with either a single or binary graft of acrylic acid (AAc) and/or poly(ethylene glycol) methacrylate (PEGMA) using gamma-radiation from {sup 60}Co to obtain PVC-g-AAc, PVC-g-PEGMA, [PVC-g-AAc]-g-PEGMA, and [PVC-g-PEGMA]-g-AAc copolymers. The outer and inner surfaces of the modified catheters were characterized using scanning electron microscopy (SEM), confocal laser microscopy (CLM) and X-ray photoelectron spectroscopy (XPS). The XPS analyses, by examining the correlation between the variation of the C{sub 1s} and O{sub 1s} content at the catheter’s surface, revealed that the catheter’s surfaces were successfully grafted with the chosen compounds, with those that were binary grafted showing a slightly more covered surface as was evidenced by the disappearance of PVC’s Cl peak. The SEM and CLM analyses revealed that catheters that had been grafted with PEGMA had a rougher outer surface as compared to those that had only been grafted with AAc. In addition, these imaging techniques showed that the inner surface of the singly grafted catheters, whether they had been grafted with AAc or PEGMA, retained some smoothness at the analyzed grafting percentages, while the binary grafted catheters showed many protuberances and greater roughness on both outer and inner surfaces.

  15. The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Bin Xiong

    Full Text Available Catheter ablation (CA for atrial fibrillation (AF is now an important therapeutic modality for patients with AF. However, data regarding changes in left atrial (LA function after CA have indicated conflicting results depending on the AF types, follow-up period, and the analytical imaging tools. The objective of this review was to analyze the effect of CA on the LA size and function for patients with AF.We searched for studies regarding LA size and function pre- and post-ablation in PubMed, Embase, the Cochrane Library, and Web of Knowledge through May 2014. LA function was measured by LA ejective fraction (LAEF, LA active ejective fraction (LAAEF, or both. Total and subgroup analyses were implemented using Cochrane Review Manager Version 5.2. Weighted mean differences with 95% confidence intervals were used to express the results of continuous outcomes using fixed or random effect models. I2 was used to calculate heterogeneity. To assess publication bias, Egger's test and Begg's funnel plot were performed using Stata 12.0.Twenty-five studies (2040 enrolled patients were selected for this meta-analysis. The LA diameter (LAD, maximum LA volume, and minimal LA volume were significantly decreased post-ablation, as compared with those at a pre-ablation visit. Compared with the pre-ablation outcomes, we found no significant differences in LAEF/LAAEF at a post-ablation follow-up. Decreases in LA volume and LAEF remained significant post-ablation for paroxysmal AF (PAF; however, the LAEF was insignificant changes in persistent AF (PeAF. Heterogeneity was significant in spite which individual study was excluded. A publication bias was not found. In a meta-regression analysis, we did not find any factor that contributed to the heterogeneity.With CA, LA volumes and LAD were decreased significantly in patients with AF; LAEF was not significant changes in patients with PeAF but decreased in those with PAF.

  16. Acquired hemophilia A that developed during the induction of hemodialysis: the use of double-filtration plasmapheresis
.

    Science.gov (United States)

    Imafuku, Aya; Sawa, Naoki; Ubara, Yoshifumi; Takaichi, Kenmei

    2017-03-01

    Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies to coagulation factor VIII (FVIII). AHA onset during the induction of dialysis is extremely rare, and the management of blood access is difficult. We present a case of AHA that developed during induction of dialysis and treatment with double filtration plasmapheresis (DFPP). An 86-year-old man with chronic kidney disease was admitted to our hospital with multiple subcutaneous hemorrhages. Because of his prolonged activated partial thromboplastin time (aPTT) and high titer of inhibitors to FVIII, he was diagnosed with AHA, and prednisolone treatment was started. After 3 weeks of steroid therapy, his renal function deteriorated, and dialysis was needed. We performed femoral catheter placement under administration of recombinant activated factor VII (rFVIIa) to prevent bleeding. The patient developed catheter-related bloodstream infection and needed arteriovenous fistula (AVF) immediately. After 4 DFPP sessions, his hemostasis recovered to normal. AVF placement did not cause any complication, and he could safely undergo maintenance hemodialysis. Clinicians should suspect AHA in end-stage renal disease patients with acute onset of bleeding and an unexplained prolonged aPTT. DFPP is useful in patients with AHA that develops during induction of dialysis and requires surgical treatment.
.

  17. Indwelling catheter care

    Science.gov (United States)

    ... an indwelling catheter are urinary incontinence (leakage), urinary retention (not being able to urinate), surgery that made ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  18. Suprapubic catheter care

    Science.gov (United States)

    ... catheter because you have urinary incontinence (leakage), urinary retention (not being able to urinate), surgery that made ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  19. Multi-center experience of 164 consecutive Hemodialysis Reliable Outflow [HeRO] graft implants for hemodialysis treatment.

    Science.gov (United States)

    Gage, S M; Katzman, H E; Ross, J R; Hohmann, S E; Sharpe, C A; Butterly, D W; Lawson, J H

    2012-07-01

    To report a multi-center experience with the novel Hemodialysis Reliable Outflow (HeRO) vascular access graft. Four centers conducted a retrospective review of end stage renal disease patients who received the HeRO device from implant to last available follow-up. Data is available on 164 patients with an accumulated 2092.1 HeRO implant months. At 6 months, HeRO primary and secondary patency is 60% and 90.8%, respectively and at 12 months, 48.8% and 90.8%, respectively. At 24 months, HeRO had a primary patency of 42.9% and secondary patency was 86.7%. Interventions to maintain or re-establish patency have been required in 71.3% of patients (117/164) resulting in an intervention rate of 1.5/year. Access related infections have been reported in 4.3% patients resulting in a rate of 0.14/1000 implant days. In our experience the HeRO device has performed comparably to standard AVGs and has proven superior to TDCs in terms of patency, intervention, and infection rates when compared to the peer-reviewed literature. As an alternative to catheter dependence as a means for hemodialysis access, this graft could reduce the morbidity and mortality associated with TDCs and have a profound impact on the costs associated with catheter related infections and interventions. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Anterior ischemic optic neuropathy in patients undergoing hemodialysis

    NARCIS (Netherlands)

    DoorenbosBot, ACC; Geerlings, W; Houtman, IA

    Four patients are discussed who underwent hemodialysis and developed anterior ischemic optic neuropathy (AION). Three patients had been treated by hemodialysis for several years. One patient developed bilateral optic neuropathy after the first hemodialysis session, So far, only four hemodialysis

  1. Solar-assisted hemodialysis.

    Science.gov (United States)

    Agar, John W M; Perkins, Anthony; Tjipto, Alwie

    2012-02-01

    Hemodialysis resource use-especially water and power, smarter processing and reuse of postdialysis waste, and improved ecosensitive building design, insulation, and space use-all need much closer attention. Regarding power, as supply diminishes and costs rise, alternative power augmentation for dialysis services becomes attractive. The first 12 months of a solar-assisted dialysis program in southeastern Australia is reported. A 24-m(2), 3-kWh rated solar array and inverter-total cost of A$16,219-has solar-assisted the dialysis-related power needs of a four-chair home hemodialysis training service. All array-created, grid-donated power and all grid-drawn power to the four hemodialysis machines and minireverse osmosis plant pairings are separately metered. After the grid-drawn and array-generated kilowatt hours have been billed and reimbursed at their respective commercial rates, financial viability, including capital repayment, can be assessed. From July of 2010 to July of 2011, the four combined equipment pairings used 4166.5 kWh, 9% more than the array-generated 3811.0 kWh. Power consumption at 26.7 c/kWh cost A$1145.79. Array-generated power reimbursements at 23.5 c/kWh were A$895.59. Power costs were, thus, reduced by 76.5%. As new reimbursement rates (60 c/kWh) take effect, system reimbursements will more than double, allowing both free power and potential capital pay down over 7.7 years. With expected array life of ∼30 years, free power and an income stream should accrue in the second and third operative decades. Solar-assisted power is feasible and cost-effective. Dialysis services should assess their local solar conditions and determine whether this ecosensitive power option might suit their circumstance.

  2. The use of HeRo catheter in catheter-dependent dialysis patients with superior vena cava occlusion.

    Science.gov (United States)

    Davis, Kathryn L; Gurley, John C; Davenport, Daniel L; Xenos, Eleftherios S

    2016-01-01

    Hemodialysis (HD) patients with superior vena cava (SVC) occlusion have limited access options. Femoral access is commonly employed but is associated with high complication rates. Hemodialysis Reliable Outflow (HeRO) catheters can be used in tunneled catheter-dependent (TCD) patients who have exhausted other access options. The HeRO graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. At our institution we have used the inside-out central venous access technique (IOCVA) to traverse an occluded vena cava for HeRO graft placement. We review our experience with this technique. A retrospective chart review was conducted of patients with HeRO graft placement at our institution. All were dependent on a tunneled femoral dialysis catheter due to central venous occlusion (CVO). The IOCVA technique was used in each case. This technique was used as last resort for patients who had no other dialysis access option. Demographics, patency rates, complications, and mortality were recorded. A total of 11 HeRO grafts were placed in 11 patients from January 2012 to June 2013, with 100% technical success rate. Three grafts were ligated due to steal syndrome. Two grafts were lost due to thrombosis. Five of 11 patients experienced a 30-day complication. Three patients died within the follow-up period; however, none were directly related to the graft placement. Follow up range was 65-573 days; 5 of 11 grafts were used for dialysis at the end of the follow-up period. The 12-month patency rate was 30%. HeRO grafts are one option for dialysis patients with CVO. There is, however, a high incidence of steal syndrome and other complications. These grafts should be offered as a final potential alternative to catheter dependence.

  3. Dedicated radial ventriculography pigtail catheter

    Energy Technology Data Exchange (ETDEWEB)

    Vidovich, Mladen I., E-mail: miv@uic.edu

    2013-05-15

    A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.

  4. Headache associated with hemodialysis

    Directory of Open Access Journals (Sweden)

    Nikić Petar M.

    2008-01-01

    Full Text Available INTRODUCTION Hemodialysis (HD is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD The study involved 126 patients (48 female and 78 male with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Kruševac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II. Subsequently, the patients were clinically evaluated and patients with headaches were further sub classified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of hemodialysis headache (HDH. RESULTS In the group of 126 evaluated patients, 41 (32.5% patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count

  5. Hemodynamics of Central Venous Catheters: experiments and simulations

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  6. A case of scrub typhus requiring maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Dae-Yeon Kim

    2013-12-01

    Full Text Available Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.

  7. The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement

    OpenAIRE

    Rehfuss, Jonathan P.; Berceli, Scott A.; Sarah M. Barbey; He, Yong; Kubilis, Paul S.; Beck, Adam W.; Huber, Thomas S.; Salvatore T Scali

    2017-01-01

    Contemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery. Methods: Bilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at...

  8. Attenuation of thrombosis and bacterial infection using dual function nitric oxide releasing central venous catheters in a 9day rabbit model.

    Science.gov (United States)

    Brisbois, Elizabeth J; Major, Terry C; Goudie, Marcus J; Meyerhoff, Mark E; Bartlett, Robert H; Handa, Hitesh

    2016-10-15

    Two major problems with implanted catheters are clotting and infection. Nitric oxide (NO) is an endogenous vasodilator as well as natural inhibitor of platelet adhesion/activation and an antimicrobial agent, and NO-releasing polymers are expected to have similar properties. Here, NO-releasing central venous catheters (CVCs) are fabricated using Elast-eon™ E2As polymer with both diazeniumdiolated dibutylhexanediamine (DBHD/NONO) and poly(lactic-co-glycolic acid) (PLGA) additives, where the NO release can be modulated and optimized via the hydrolysis rate of the PLGA. It is observed that using a 10% w/w additive of a PLGA with ester end group provides the most controlled NO release from the CVCs over a 14d period. The optimized DBHD/NONO-based catheters are non-hemolytic (hemolytic index of 0%) and noncytotoxic (grade 0). After 9d of catheter implantation in the jugular veins of rabbits, the NO-releasing CVCs have a significantly reduced thrombus area (7 times smaller) and a 95% reduction in bacterial adhesion. These results show the promise of DBHD/NONO-based NO releasing materials as a solution to achieve extended NO release for longer term prevention of clotting and infection associated with intravascular catheters. Clotting and infection are significant complications associated with central venous catheters (CVCs). While nitric oxide (NO) releasing materials have been shown to reduce platelet activation and bacterial infection in vitro and in short-term animal models, longer-term success of NO-releasing materials to further study their clinical potential has not been extensively evaluated to date. In this study, we evaluate diazeniumdiolate based NO-releasing CVCs over a 9d period in a rabbit model. The explanted NO-releasing CVCs were found to have significantly reduced thrombus area and bacterial adhesion. These NO-releasing coatings can improve the hemocompatibility and bactericidal activity of intravascular catheters, as well as other medical devices (e

  9. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

    DEFF Research Database (Denmark)

    Regeur, L; Colding, H; Jensen, H

    1977-01-01

    The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44...... renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between...... the half-life of amikacin and the decrease in blood urea and serum creatinine was demonstrated. The pharmacokinetic data were used to make dosage regimen recommendations for the treatment of patients undergoing intermittent hemodialysis or peritoneal dialysis....

  10. [Hemodialysis and cardiovascular outcome].

    Science.gov (United States)

    Panicali, Laura; Brigante, Fabiana; Mancini, Elena

    2017-03-01

    Hemodialysis patients often present multiple comorbidities and have a high mortality rate (15-20% per year), mostly due to cardiovascular events. Besides predisposing pathological conditions related to uremia (heart failure, coronary heart disease, left ventricular hypertrophy, arrhythmias), they also have specific risk factors linked to the hemodialysis (HD) treatment in itself: chronic inflammation, fluid overload, autonomic nervous system dysfunction, arterovenous fistula. These factors may affect the hemodynamic compensatory systems (vascular refilling, arteriolar and venous tone, autonomic nervous system response) to fluid removal, with high risk of intra-dialysis hypotension (IDH) episodes or arrhythmic events. IDH is recognized as associated to a negative long term outcome, due to the repeated episodes of organ hypoperfusion with ischemic damage to heart, brain and gut. Over the years, dialysis technology has greatly improved, with the development of continuous and noninvasive monitoring systems, able to control some hemodynamic parameters affecting blood pressure (mainly blood volume and body temperature), with positive results in terms of hemodynamic instability during HD. Furthermore, recent studies suggest that hemodiafiltration may reduce the risk of IDH and cardiovascular mortality, compared with conventional HD. Diabetic and/or old patients, as well as those with a previous cardiovascular event, are the first patients who should receive the new treatment options. Overall, the HD prescription needs to be tailored to each patient's need, to improve the hemodynamic tolerance to treatment and the cardiovascular outcome. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

  11. Adequacy of hemodialysis in Nepalese patients undergoing maintenance hemodialysis

    OpenAIRE

    P Sultania; Sanjib Kumar Sharma; Sharma SK

    2009-01-01

    INTRODUCTION: Inadequate dialysis accounts for the high mortality in patients with end stage renal disease (ESRD). In Nepal, due to various factors including financial and logistic limitations, hemodialysis is mostly performed twice-a-week. This study was undertaken to look at adequacy of dialysis in patients undergoing maintenance hemodialysis in Nepal where the patients profile, in terms of diet, body muscle mass, nutritional status etc are different from western world. METHODS: In...

  12. Evaluation of the conformity of assistential practice in the maintenance of the temporary double-lumen dialysis catheter

    Directory of Open Access Journals (Sweden)

    Késia Alves Gomes Rosetti

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the conformity of the assistential practice in the maintenance of the temporary double-lumen catheter for hemodialysis, by means of the use of the process indicator, in the University Hospital of the University of São Paulo. METHOD: a quantitative, exploratory-descriptive and observational study. The sample was made up of 155 observations of persons with temporary double-lumen catheters, in the period March - November 2011, using the Indicator of the Maintenance of the Temporary Double Lumen Catheter for Hemodialysis. RESULTS: the rate of general conformity of the assistential practice corresponded to 65.8%. Of the practice's 13 components, 9 (69.2% attained 100% conformity. The hygienization of hands by the professionals and the use of a mask by the patients during the disconnection from the hemodialysis had the worst rates (83.9%. CONCLUSION: although the actions evaluated are implemented in the unit, it is necessary to propose and apply educational strategies with the health team, as well as to institute periodical assessments, so as to raise the conformity rates, ensuring the quality of the hemodialysis services.

  13. Evaluation of the conformity of assistential practice in the maintenance of the temporary double-lumen dialysis catheter.

    Science.gov (United States)

    Rosetti, Késia Alves Gomes; Tronchin, Daisy Maria Rizatto

    2014-01-01

    to evaluate the conformity of the assistential practice in the maintenance of the temporary double-lumen catheter for hemodialysis, by means of the use of the process indicator, in the University Hospital of the University of São Paulo. a quantitative, exploratory-descriptive and observational study. The sample was made up of 155 observations of persons with temporary double-lumen catheters, in the period March-November 2011, using the Indicator of the Maintenance of the Temporary Double Lumen Catheter for Hemodialysis. the rate of general conformity of the assistential practice corresponded to 65.8%. Of the practice's 13 components, 9 (69.2%) attained 100% conformity. The hygienization of hands by the professionals and the use of a mask by the patients during the disconnection from the hemodialysis had the worst rates (83.9%). although the actions evaluated are implemented in the unit, it is necessary to propose and apply educational strategies with the health team, as well as to institute periodical assessments, so as to raise the conformity rates, ensuring the quality of the hemodialysis services.

  14. Bladder Morphology Using 2 Different Catheter Designs

    Science.gov (United States)

    2017-04-10

    Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

  15. Central Venous Catheter (Central Line)

    Science.gov (United States)

    ... venous catheter (KATHeter), also known as a central line or CVC, is long, soft, thin, hollow tube ... into a large vein (blood vessel). A central line is much like an intravenous (IV) catheter that ...

  16. Hemodialysis: stressors and coping strategies.

    Science.gov (United States)

    Ahmad, Muayyad M; Al Nazly, Eman K

    2015-01-01

    End-stage renal disease (ESRD) is an irreversible and life-threatening condition. In Jordan, the number of ESRD patients treated with hemodialysis is on the rise. Identifying stressors and coping strategies used by patients with ESRD may help nurses and health care providers to gain a clearer understanding of the condition of these patients and thus institute effective care planning. The purpose of this study was to identify stressors perceived by Jordanian patients on hemodialysis, and the coping strategies used by them. A convenience sample of 131 Jordanian men and women was recruited from outpatients' dialysis units in four hospitals. Stressors perceived by participants on hemodialysis and the coping strategies were measured using Hemodialysis Stressor Scale, and Ways of Coping Scale-Revised. Findings showed that patients on hemodialysis psychosocial stressors scores mean was higher than the physiological stressors mean. Positive reappraisal coping strategy had the highest mean among the coping strategies and the lowest mean was accepting responsibility. Attention should be focused towards the psychosocial stressors of patients on hemodialysis and also helping patients utilize the coping strategies that help to alleviate the stressors. The most used coping strategy was positive reappraisal strategy which includes faith and prayer.

  17. Epidemiological characteristics of patients starting chronic hemodialysis in the Alberto Sabogal Sologuren Hospital 2015

    Directory of Open Access Journals (Sweden)

    Luis Huamán C

    2016-02-01

    Full Text Available Objective: To identify the epidemiological characteristics of patients starting chronic hemodialysis during 2015 in the Alberto Sabogal Sologuren, EsSalud Hospital. Callao, Peru. Material and Methods: Observational and descriptive cross-sectional study. The study population consisted of 30 patients who started chronic hemodialysis therapy in the Alberto Sabogal Sologuren, Hospital EsSalud. Information was obtained through a form developed by the researcher through two sources; medical history and by reference of the same patient and / or family. The main epidemiological variables collected were: personal and clinical data, emphasizing the latter on the previous control in pre dialysis stage, that is, if the patients had some preparation by a team of renal dialysis health professionals for their scheduled entry for dialysis. Results: The mean age was 62.3 years, and 53.3% of patients were older than 60 years. The mode of admission was by emergency: 73.3%, and 13.3% for surgery and hospitalization. The type of access used 86.7% temporary catheter; 10% arteriovenous fistula and 3.3% tunneled catheter. Diabetes and hypertension with 36.7% and 33.3% respectively were the most common causes of CKD. Conclusion: Half of patients, who started hemodialysis were beyond the sixth decade of life and came in poor clinical, gasometry and biochemical conditions. A large proportion of patients admitted for emergency rooms with the consequent negative impact on the economy and survival of patients. The most common vascular access for hemodialysis was the temporary catheter.

  18. Vitamin D deficiency in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2012-01-01

    Full Text Available Background : Vitamin D [(25(OHD] deficiency and insufficiency is common in patients with chronic kidney disease (CKD. 25(OHD has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis. Materials and Methods : We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity, Gurgaon. 25(OHD levels were measured with radioimmunoassay (Diasorin method and parathyroid hormone (PTH was measured using electrochemiluminiscence immunoassay (ECLIA. Results : The mean age of patients was 55 ± 13 years. 32/45 (71% were males. 23/45 (51% were diabetics. The median duration of hemodialysis was 5.5 months (range 1-74 months. 33/45 (74% patients were on thrice weekly hemodialysis. The mean level of vitamin D was 10.14 ± 8.7 ng/ml. Majority of the patients [43/45 (95.5%] were either vitamin D deficient or had insufficient levels. 40/45 (88.9% were vitamin D deficient (levels <20 ng/ml; of these, 29/40 (64.4% had severe vitamin D deficiency (levels <10 ng/ml and 3/45 (6.7% had insufficient levels (20-30 ng/ml of vitamin D. Only 2/45 (4.4% patients had normal levels of vitamin D. 23/45 (51% of patients were receiving calcitriol. The mean levels of serum calcium, phosphorus, alkaline phosphatase, and albumin were 8.8 ± 0.64 mg/dl, 5.0 ± 0.7 mg/dl, 126 ± 10.3 IU/l and 3.6 ± 0.62 g/dl, respectively. PTH levels ranged from 37 to 1066 pg/ml, and the median was 195.8 pg/ml. There was a weak correlation between 25(OHD levels and weight, sex, hemoglobin, albumin, alkaline phosphatase, and presence of diabetes. There was, however, no correlation with duration of dialysis or PTH levels. Conclusion : Vitamin D deficiency and insufficiency are universal in our hemodialysis patients, with severe vitamin D deficiency in two-third of patients.

  19. Hemodialysis-related headaches

    Directory of Open Access Journals (Sweden)

    Đurić Marija

    2007-01-01

    Full Text Available Background/Aim. Hemodialysis (HD is a therapeutic procedure used to partially correct homeostatic disorders and prevent complications of uremia to appear in the terminal stage of renal insufficiency. The aim of this study was to evaluate and analyze the incidence and features of headaches in patients undergoing hemodialysis. Methods. A total of 143 patients, 50 women and 93 men, undergoing hemodialysis, were questioned about their problems with headache using a questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. The patients were separated into two groups: the patients without headache and the patients with repeated headaches. Afterwards, the patients with headaches were further divided into subgroups: the patients who had the headaches before the beginning of HD and patients who experienced repeated headaches with the beginning of HD headache (HDH. In the group of patients with headaches we analyzed characteristics of headache according to which diagnoses of headaches were made, as well as the effects of HD on headaches. We also analyzed features of HDH. The patients with headache were compared to the patients without headache regarding sex, age, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure and serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The results were statistically compared. Results. In the group of 143 patients examined, 27 (18.9% patients had headaches. There were no statistically significant differences between the group of patients with headaches and those without headache regarding to sex, age, duration of HD, causes of end-stage renal disease, serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The patients with headaches showed significantly higher mean values of systolic blood pressure during HD in comparison to the patients

  20. Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico.

    Science.gov (United States)

    Martínez-Mier, Gustavo; Luna-Castillo, Marisol; Ortiz-Enríquez, Jorge J; Avila-Pardo, Sandro F; Fernández, Vicente; Méndez-López, Marco T; Budar-Fernández, Luis; González-Velázquez, Felipe

    2012-05-14

    Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. Determine risk factors for early catheter dysfunction that result in the need for replacement. We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement.

  1. The Relationship Between Hemodialysis and the Echocardiographic Findings in Patients with Chronic Kidney Disease.

    Science.gov (United States)

    Omrani, Hamidreza; Golshani, Sanam; Sharifi, Vahid; Almasi, Afshin; Sadeghi, Masoud

    2016-10-01

    The incidence of cardiac morbidity and mortality is high in patients treated with hemodialysis (HD). The aim of this study was to evaluate the relationship between HD and the echocardiographic findings in patients with chronic kidney disease (CKD). Between 2012 and 2014, 150 patients with CKD. The echocardiographic data were done based on American Society of Cardiology (ASE). Measurement method for Ejection Fraction was E balling and for Diastolic Function was Tissue Doppler. Anemia, thyroid conditions and dialysis through an arteriovenous fistula or permanent catheter of dialysis for the patients are not considered. The mean age at diagnosis for the patients was 57.8 years, 52.7% were males. Out of 150 patients, 112 patients (74.7%) had diabetes and 117 patients (78%) had a history of hypertension. The prevalence of all echocardiographic findings was more after the first dialysis compared with before the first dialysis in diabetic patients (Pdiabetic patients, was not for the tricuspid valve stenosis, impaired right ventricular volume, systolic dysfunction and pulmonary hypertension (P>0.05). According to the findings of this study, seems that more accurate selection of patients for dialysis, paying special attention to hemodynamic change during dialysis, patient education about diet and better control of uremia and diabetes is essential.

  2. Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Maria do Sameiro-Faria

    2013-01-01

    Full Text Available Background. End-stage renal disease (ESRD patients under hemodialysis (HD have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ± 13.9 years old, including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dysfunction markers, and dialysis adequacy. Results. 35 patients (18.5% died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP, and triglycerides (TG are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC (Hazard ratio [HR] =3.03, 95% CI = 1.49–6.13, with higher CRP levels (fourth quartile, compared with those with lower levels (first quartile (HR = 17.3, 95% CI = 2.40–124.9. Patients with higher TG levels (fourth quartile presented a lower risk of death, compared with those with the lower TG levels (first quartile (HR = 0.18, 95% CI = 0.05–0.58. Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients.

  3. Catheter-Directed Thrombolysis

    Science.gov (United States)

    ... in 1,000. There is a very slight risk of an allergic reaction if contrast material is injected. Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, ...

  4. Totally implantable venous catheters for chemotherapy: experience in 500 patients

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    Full Text Available CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2% catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use, 11 obstructions (0.06/1000 days of catheter use and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use. Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.

  5. Second-Degree Interatrial Block in Hemodialysis Patients

    Science.gov (United States)

    Enriquez, Andres; D'Amato, Anna; de Luna, Antoni Bayes; Baranchuk, Adrian

    2015-01-01

    Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB. PMID:25755895

  6. Second-Degree Interatrial Block in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Andres Enriquez

    2015-01-01

    Full Text Available Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB.

  7. Scintigraphic method to test the function of intraperitoneal draining catheters for regional intraabdominal chemotherapy; Szintigraphische Ueberpruefung der Funktion intraperitoneal liegender Katheter zur regionalen intraabdominellen Chemotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, K.F.; Hamann, A.; Hundeshagen, H. [Zentrum Radiologie, Klinik fuer Nuklearmedizin, Medizinische Hochschule Hannover (Germany); Jaehne, J.; Piso, P.; Pichlmayr, R. [Zentrum Chirurgie, Klinik fuer Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover (Germany)

    1997-12-01

    To prove the functionality of the catheter a scintigraphic method is introduced using a liquid solution of sodium chloride - Tc-99m-Diethylenetriaminepentaacetic acid (Tc-99m-DTPA) (500 ml). This study was aimed to look for problems over the period of application and to measure the intraperitoneal distribution and resorption of the fluid. One leakage and 3 revisible obstructions occurred in 26 applications done in 20 patients. The upper right and the central abdomen was not reached as extensive as the other regions. The abdomen was divided into 9 regions of equal size. In 4 out of 19 patients (20%) the fluid tracer was missed in more than 3 regions (up to 40% of the total area). It is early to decide whether methological modifications are necessary in these cases, but closed chemotherapies in patients with maldistribution may not be indicated. This will be in particular necessary if there is a relation between the maldistribution and the location of recurrencies. The demonstrated simple scintigraphic method, however, is able to recognize patients at risk. (orig./MG) [Deutsch] Zur Verwendung vorgeschlagen wird die Applikation von Tc-99m-DTPA, durchmischt in 500 ml 0,9%iger NaCl-Loesung. Applikationsprobleme, die intraperitoneale Verteilung und der zeitliche Verlauf der Resorption des Tracers werden anhand von 26 Applikationen an 20 Patienten dargestellt. Eine Leckage und drei Partialverschluesse, die sich umgehend revidieren liessen, traten auf. Es zeigte sich, dass ueber den Periotoneal-Dialyse-Katheter das obere und auch das rechte Abdomen sowie die zentrale Region weniger gut erreicht werden. Im Einzelfall koennen erhebliche Fehlverteilungen vorliegen: Bis zu 40% des Abdomens bleiben tracerfrei. Bei groben Fehlverteilungen ist die Indikation zur erneuten regionalen Chemotherapie sehr zurueckhaltend zu sehen. Allerdings lassen sich aufgrund der derzeitigen Datenlage konzeptionelle Rueckschluesse oder Aenderungen des individuellen Therapiekonzepts nicht begruenden

  8. Erectile dysfunction in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Imen Gorsane

    2016-01-01

    Full Text Available Erectile dysfunction (ED is a common problem seen among patients on hemodialysis (HD, but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5% and diabetes (41.6%. The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH, follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%, the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

  9. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

    Directory of Open Access Journals (Sweden)

    Masato Kimura

    2017-01-01

    Full Text Available Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

  10. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia.

    Science.gov (United States)

    Kimura, Masato; Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

    2017-01-01

    Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

  11. Successful prevention of tunneled, central catheter infection by antibiotic lock therapy using vancomycin and gentamycin.

    Science.gov (United States)

    Al-Hwiesh, Abdulla K; Abdul-Rahman, Ibrahiem Saeed

    2007-06-01

    Tunneled, cuffed central vein catheters (TCC) are widely used for delivering hemodialysis (HD). Among the complications associated with central vein catheters in HD patients, infection is the principal cause of morbidity and mortality. The optimal strategy for management of TCC infections is unclear. This prospective study was aimed at assessing the efficacy of antibiotic-lock therapy using vancomycin and gentamycin in preventing catheter-related blood stream bacterial infection in patients on HD. A total of 63 HD patients with 81 TCC were enrolled at the time of catheter insertion. Patients were randomized into two groups: Group I (33 patients, 37 insertions) included TCC with antibiotic lock therapy and Group II (30 patients, 44 insertions) with routine TCC management. Infection-free catheter survival of both groups was evaluated and compared at the end of the 12-month study period. A total of 57 TCC infections were encountered with an incidence rate of 8.95 infections per 1000 dialysis sessions (DS). The rate of infection was significantly lower in Group I (4.54 per 1000 DS) as compared to Group II (13.11 per 1000 DS), p 0.05). Our study suggests that antibiotic-lock therapy using a combination of vancomycin and gentamycin is useful in preventing catheter-related blood stream infection in patients on HD.

  12. A systematic review and meta-analysis of the influence of peritoneal dialysis catheter type on complication rate and catheter survival.

    Science.gov (United States)

    Hagen, Sander M; Lafranca, Jeffrey A; IJzermans, Jan N M; Dor, Frank J M F

    2014-04-01

    Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. There are several configurations of PD catheter design that may impact catheter function, such as the shape of the intraperitoneal segment, the number of cuffs, and the subcutaneous configuration. This review and meta-analysis was carried out to determine whether there is a clinical advantage for one of the catheter types or configurations. Comprehensive searches were conducted in MEDLINE, Embase, and CENTRAL (the Cochrane Library 2012, issue 10). The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the PRISMA statement. The initial search yielded 682 hits from which 13 randomized controlled trials were identified. Outcomes of interest were as follows: catheter survival, drainage dysfunction, migration, leakage, exit-site infections, peritonitis, and catheter removal. Comparing straight vs. swan neck and single vs. double-cuffed catheters, no differences were found when results were pooled. Comparison of straight vs. coiled-tip catheters demonstrated that survival was significantly different in favor of straight catheters (hazard ratio 2.05; confidence interval 1.10-3.79, P=0.02). For surgically inserted catheters, the removal rate and survival at 1 year after insertion were significantly in favor of straight catheters. Our meta-analysis clearly demonstrates benefits for catheters with a straight intraperitoneal segment.

  13. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt

    Directory of Open Access Journals (Sweden)

    Mourad B

    2014-11-01

    Full Text Available Basma Mourad,1 Doaa Hegab,1 Kamal Okasha,2 Sarah Rizk3 1Dermatology and Venereology Department, 2Internal Medicine Department, Faculty of Medicine, Tanta University, 3Ministry of Health, Tanta, EgyptIntroduction: Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients.Patients and methods: Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV antibodies were evaluated.Results: This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level

  14. Catheter associated urinary tract infections.

    Science.gov (United States)

    Nicolle, Lindsay E

    2014-01-01

    Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.

  15. Catheter associated urinary tract infections

    Science.gov (United States)

    2014-01-01

    Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation. PMID:25075308

  16. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    Reliable methods for cardiac output determination are essential for studying the pathophysiology of intradialytic hypotension. Use of the current gold standard, the Transonic monitor, requires an arteriovenous fistula. We wished to verify the accuracy of a method based on finger pulse contour...... analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...... of immediately successive measurements. The variability of successive FNM measurements was small (bias 0.28%, SD +/- 6.1%; NS). The absolute cardiac output values reported by the FNM were unreliable (bias 20.1%, SD +/- 35.3%; P...

  17. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

    Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E

    2011-01-01

    A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study...... to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial included patients with and without diabetes, we conducted a post hoc analysis to determine whether rosuvastatin might reduce the risk of cardiac events in diabetic patients...... receiving hemodialysis. Among the 731 participants with diabetes, traditional risk factors such as LDL-C, smoking, and BP did not associate with cardiac events (cardiac death and nonfatal myocardial infarction). At baseline, only age and high-sensitivity C-reactive protein were independent risk factors...

  18. Phosphate kinetic models in hemodialysis

    DEFF Research Database (Denmark)

    Laursen, Sisse Heiden; Vestergaard, Peter; Hejlesen, Ole K.

    2018-01-01

    BACKGROUND: Understanding phosphate kinetics in dialysis patients is important for the prevention of hyperphosphatemia and related complications. One approach to gain new insights into phosphate behavior is physiologic modeling. Various models that describe and quantify intra- and/or interdialytic...... phosphate kinetics have been proposed, but there is a dearth of comprehensive comparisons of the available models. The objective of this analysis was to provide a systematic review of existing published models of phosphate metabolism in the setting of maintenance hemodialysis therapy. STUDY DESIGN......: Systematic review. SETTING & POPULATION: Hemodialysis patients. SELECTION CRITERIA FOR STUDIES: Studies published in peer-reviewed journals in English about phosphate kinetic modeling in the setting of hemodialysis therapy. PREDICTOR: Modeling equations from specific reviewed studies. OUTCOMES: Changes...

  19. Biofeedback systems and adaptive control hemodialysis treatment

    Directory of Open Access Journals (Sweden)

    Azar Ahmad

    2008-01-01

    Full Text Available On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient′s plasma conductivity can be calculated easily from on-line measurements at two different steps of dialysate conductivity. A bio-feedback system has been devised to calculate the patient′s plasma conductivity and modulate the conductivity of the dialysate continuously in order to achieve a desired end-dialysis patient plasma conductivity corresponding to a desired end-dialysis plasma sodium concentration. Another bio-feedback system can control the body tempe-rature by measuring it at the arterial and venous lines of the extra-corporeal circuit, and then modulating the dialysate temperature in order to stabilize the patients′ temperature at constant values that result in improved intra-HD cardiovascular stability. The module can also be used to quantify vascular access recirculation. Finally, the simultaneous computer control of ultrafiltration has proven the most effective means for automatic blood pressure stabilization during hemo-dialysis treatment. The application of fuzzy logic in the blood-pressure-guided biofeedback con-trol of ultrafiltration during hemodialysis is able to minimize HD-induced hypotension. In con-clusion, online monitoring and adaptive control of the patient during the dialysis session using the bio-feedback systems is expected to render the process of renal replacement therapy more physiological and less eventful.

  20. Hemodialysis in children weighing less than 15 kg: a single-center experience.

    Science.gov (United States)

    Kovalski, Yael; Cleper, Roxana; Krause, Irit; Davidovits, Miriam

    2007-12-01

    Despite significant technical improvements, hemodialysis in infants with end-stage renal disease (ESRD) is still associated with significant morbidity and mortality. The files of patients weighing less than 15 kg with ESRD who were treated with hemodialysis at our institute between 1995 and 2005 were reviewed for background and treatment characteristics, morbidity and outcome. The study group included 11 patients aged 7-75 months (mean 34.2 months) weighing 7.2-14.9 kg (mean 10.9 kg). Mean duration of dialysis was 11.3 months. Vascular access posed the major problem. Ten patients were dialyzed through a central venous cuffed catheter and one through an arteriovenous fistula. An average of three different vascular accesses was required per patient (range 1-9). Mechanical difficulties were the most common cause of central-line removal (56.5%), followed by infections (15.6%). Major complications causing significant morbidity were intradialytic hemodynamic instability, hyperkalemia, coagulation within the dialysis set, anemia, hypertension, inadequate fluid removal, and recurrent hospitalizations. Analysis of outcome revealed that eight patients underwent successful transplantation, one returned for hemodialysis after 4.5 years due to graft failure, and two died. Hemodialysis is a suitable option for low-weight pediatric patients with ESRD awaiting transplantation when performed in highly qualified centers.

  1. Enterococcus faecalis endophthalmitis as a metastatic complication of hemodialysis vascular access-related sepsis: A case report and review of the literature.

    Science.gov (United States)

    Sahin, Osman Zikrullah; Kara, Ekrem; Belice, Tahir; Ayaz, Teslime; Baydur Sahin, Serap; Ozturk, Cinar; Yildirim, Safak; Metin, Yavuz; Sahutoglu, Tuncay

    2016-07-01

    Catheter and/or arteriovenous (A-V) graft-related bacteremia is an important cause of morbidity and mortality among hemodialysis (HD) patients. Endocarditis, septic arthritis, epidural abscess, septic embolism, and osteomyelitis are the most common complications of catheter and/or A-V graft-related bacteremia; however, endogenous endophthalmitis is rarely seen. To the best of our knowledge, Enterococcus faecalis is the first case report in this population. We hereby report a case of endogenous endophthalmitis caused by E. faecalis as a complication of catheter and/or A-V graft-related bacteremia in a diabetic patient, who was undergoing HD for 5 years. We also discuss the etiology, clinical features, and outcomes of endogenous endophthalmitis in HD patients with a brief review of the literature. Although broad-spectrum parenteral (intravenous and intravitreal) antibiotics were used for 4 weeks, evisceration of the left eye could not be avoided. Endogenous endophthalmitis is a rare but rapidly blinding complication of catheter and/or A-V graft-related bacteremia in HD patients. It can develop as a result of silent catheter and/or A-V graft infections, which may lead to recurrent bacteremia. E. faecalis should be considered as a pathogen in this population who had recent history of catheter or A-V graft procedure. © 2015 International Society for Hemodialysis.

  2. [Catheter ablation in supraventricular tachycardia].

    Science.gov (United States)

    Pitschner, H F; Neuzner, J

    1996-01-01

    The first report about successful radio frequency ablation of a right-posterior-septal accessory pathway appeared in 1986. Since then, the technology of both guidable ablation catheters and radio frequency generators has been considerably improved in an initially clinical-experimental phase. At the same time, electrophysiologists were equally able to enlarge their knowledge in the field of signal characteristics of arrhythmogenic substrates. This included the discovery of action potentials of accessory pathways (preexcitation syndromes), the location of fast and slow AV node conduction (AV nodal reentrant tachycardia, AVNRT), the functional importance of the anatomical isthmus between the os of the coronary sinus, the tricuspid valve and the inferior caval vein (atrial flutter). Mapping techniques such as transient and concealed entrainment became, among others, significant tools in finding the best localization for radio frequency catheter ablation. Thus, technical development and the increased knowledge of clinical electrophysiologists resulted in firmly establishing the procedure of catheter ablation as the method of first choice in the curative treatment of supraventricular tachycardias in a potential collective of about 5 per mill of the normal population (without atrial fibrillation). Supraventricular tachycardias with a reentry mechanism in the broadest sense (> 95% of all pts. with SVT) and those with focal automaticity ( 90% versus uncommon type 90%). Atrial reentrant tachycardias are rather rare (with the exception of atrial fibrillation/flutter). The literature suggests medical therapy to be successful in about 60% of these patients. Those patients who are presently proposed to receive radio frequency catheter ablation usually continue to be symptomatic despite pharmacological therapy and/or have a potential risk for sudden cardiac death due to atrial fibrillation in WPW syndrome, or rate-dependent hemodynamic compromise secondary to cardiac disease

  3. Central Venous Catheter Insertion Site and Colonization in Pediatric Cardiac Surgery

    Science.gov (United States)

    2017-11-04

    Central Line-associated Bloodstream Infection (CLABSI); Central Venous Catheter Associated Bloodstream Infection; Heart; Surgery, Heart, Functional Disturbance as Result; Congenital Heart Disease; Newborn; Infection

  4. PRESCRIPTION AND ADEQUACY OF HEMODIALYSIS

    Directory of Open Access Journals (Sweden)

    I Gde Raka Widiana

    2013-10-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 Physiologically, uremic syndrome is a pollutional phenomenone of body fluid caused by uremic substance retention due to failing kidney. Hemodialysis (HD is a substitution therapy to replace native kidney to filter out the toxic substances. The clearance capacity can be measured using urea kinetic modeling, where urea is used as a marker. Prescription of HD will produced prescribed KT/V, namely the amount of HD doses given. On the other hand delivered KT/V is real clearance effect occurred in the body. Each component of dialysis machine can be adjusted to produce adequate delivered KT/V. This KT/V has also to be adjusted with weekly frequency of HD and residual function of the native kidney. Value of KT/V in each HD session according the consensus has to be attained in order the patient live a better life longer /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  5. Neurotoxicity caused by valacyclovir in a patient on hemodialysis

    NARCIS (Netherlands)

    Linssen-Schuurmans, CD; van Kan, EJM; Feith, GW; Uges, DRA

    The authors report toxicity caused by valacyclovir in a patient on hemodialysis. After initial recuperation resulting from treatment with hemodialysis, the patient experienced a relapse of neurologic symptoms, again necessitating hemodialysis. Although acyclovir and its analogues are generally safe

  6. Between the lines: The 50th anniversary of long-term central venous catheters.

    Science.gov (United States)

    Gow, Kenneth W; Tapper, David; Hickman, Robert O

    2017-05-01

    Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

    Bjarnason, N H; Munkner, R; Kampmann, J P

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenari...

  8. Ultrapure dialysate for home hemodialysis?

    Science.gov (United States)

    Ouseph, Rosemary; Ward, Richard A

    2007-07-01

    Use of ultrapure dialysate (bacteria home hemodialysis. More frequent dialysis also appears to reduce inflammation, and whether combining more frequent dialysis with use of ultrapure dialysate will have an additive effect on inflammation and its consequences remains unclear. Routinely producing ultrapure dialysate in a home environment with a conventional hemodialysis machine poses technical challenges related to the design of the equipment and the intermittent nature of hemodialysis. Solutions to these problems include use of a system in which the water-treatment equipment is fully integrated with the dialysis machine, use of dry-powder cartridges or sterile prepackaged liquids for bicarbonate concentrate, and use of a bacteria-retentive and endotoxin-retentive filter for final purification of the dialysate immediately before it enters the dialyzer. Alternatively, ultrapure dialysate may be achieved with newer machines designed specifically for home hemodialysis that use a new batch of dialysate for each treatment. The volume of dialysate available with these machines, however, currently limits their use to short-daily dialysis.

  9. Changes in Plasma Copeptin Levels during Hemodialysis : Are the Physiological Stimuli Active in Hemodialysis Patients?

    NARCIS (Netherlands)

    Ettema, Esmee M.; Kuipers, Johanna; Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.; Franssen, Casper F. M.

    2015-01-01

    Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli

  10. Hyperprolactinemia in end-stage renal disease and effects of frequent hemodialysis.

    Science.gov (United States)

    Lo, Joan C; Beck, Gerald J; Kaysen, George A; Chan, Christopher T; Kliger, Alan S; Rocco, Michael V; Chertow, Glenn M

    2017-04-01

    End-stage renal disease is associated with elevations in circulating prolactin concentrations, but the association of prolactin concentrations with intermediate health outcomes and the effects of hemodialysis frequency on changes in serum prolactin have not been examined. The FHN Daily and Nocturnal Dialysis Trials compared the effects of conventional thrice weekly hemodialysis with in-center daily hemodialysis (6 days/week) and nocturnal home hemodialysis (6 nights/week) over 12 months and obtained measures of health-related quality of life, self-reported physical function, mental health and cognition. Serum prolactin concentrations were measured at baseline and 12-month follow-up in 70% of the FHN Trial cohort to examine the associations among serum prolactin concentrations and physical, mental and cognitive function and the effects of hemodialysis frequency on serum prolactin. Among 177 Daily Trial and 60 Nocturnal Trial participants with baseline serum prolactin measurements, the median serum prolactin concentration was 65 ng/mL (25th-75th percentile 48-195 ng/mL) and 81% had serum prolactin concentrations >30 ng/mL. While serum prolactin was associated with sex (higher in women), we observed no association between baseline serum prolactin and age, dialysis vintage, and baseline measures of physical, mental and cognitive function. Furthermore, there was no significant effect of hemodialysis frequency on serum prolactin in either of the two trials. Serum prolactin concentrations were elevated in the large majority of patients with ESRD, but were not associated with several measures of health status. Circulating prolactin levels also do not appear to decrease in response to more frequent hemodialysis over a one-year period. © 2016 International Society for Hemodialysis.

  11. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management.

    Science.gov (United States)

    Feld, R; Wechsler, R J; Bonn, J

    1997-08-01

    Our purpose was to report the use of percutaneous catheter drainage as a therapeutic option in the management of three patients with biliary-pleural fistulas without biliary obstructions. In the proper clinical setting, the CT findings of liver dome laceration or abscess, diaphragm disruption, and pleural effusion should suggest biliary-pleural fistula. Percutaneous catheter management can be curative or serve a temporizing function before surgery.

  12. Foley catheters functionalised with a synergistic combination of antibiotics and silver nanoparticles resist biofilm formation.

    Science.gov (United States)

    Mala, Rajendran; Annie Aglin, Antony; Ruby Celsia, Arul Selvaraj; Geerthika, Sivalingam; Kiruthika, Narbahvi; VazagaPriya, Chinnathambi; Srinivasa Kumar, Kumarapillai

    2017-08-01

    Foley catheters are inevitable in health care unit. Pathogens colonise and form biofilm on catheter causing catheter-associated urinary tract infection. Therefore, the authors aimed to functionalise catheter to resist biofilm formation. The authors impregnated urinary catheters with a synergistic combination of antibiotics and silver nanoparticles (SNPs) to evaluate antibiofilm efficacy in vitro and in vivo . SNPs were synthesised using Spirulina platensis . Synergy between the SNPs and antibiotics was determined by the checker-board method. In vivo efficacy of the functionalised catheters was assessed in mice. Liver and kidney function tests of mice were performed. The in vitro anti-adherence activity of the functionalised catheters was evaluated after 2 years. Nanoparticle sizes were 42-75 nm. Synergistic activity was observed among SNPs (2 µg/ml), amikacin (6.25 µg/ml), and nitrofurantoin (31.25 µg/ml). In mice, catheters functionalised with combinations of antibiotics and SNPs exhibited no colonisation until Day 14. Blood, liver, and kidney tests were normal. After 2 years, catheters functionalised with antibiotics exhibited 25% inhibition of bacterial adhesion, and catheters functionalised with the nanoparticle-antibiotic combination exhibited 90% inhibition. Impregnation of urinary catheters with a synergistic combination of antibiotics and SNPs is an efficient and promising method for preventing biofilm formation.

  13. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

    Directory of Open Access Journals (Sweden)

    Godelieve Alice Goossens

    2015-01-01

    Full Text Available Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient’s condition.

  14. Central venous catheter - dressing change

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000156.htm Central venous catheter - dressing change To use the sharing features on this page, please enable JavaScript. You have a central venous catheter. This is a tube that goes into a ...

  15. Agile and Bright Intracardiac Catheters

    NARCIS (Netherlands)

    M. Pekař (Martin)

    2017-01-01

    markdownabstractIntracardiac imaging catheters represent unique instruments to diagnose and treat a diseased heart. While there are imminent advances in medical innovation, many of the commercially available imaging catheters are outdated. Some of them have been designed more than 20 years and

  16. Early infection risk with primary versus staged Hemodialysis Reliable Outflow (HeRO) graft implantation.

    Science.gov (United States)

    Griffin, Andrew S; Gage, Shawn M; Lawson, Jeffrey H; Kim, Charles Y

    2017-01-01

    This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation. A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component. Within the staged implantation group, 32 were performed via an existing tunneled hemodialysis catheter (incidentally staged), and 55 were performed via a tunneled catheter inserted across a central venous occlusion in an interventional radiology suite specifically for HeRO implantation (intentionally staged). Early infection was defined as episodes of bacteremia or HeRO infection requiring resection ≤30 days of HeRO implantation. For staged HeRO implantations, the median interval between tunneled catheter insertion and conversion to a HeRO graft was 42 days. The overall HeRO-related infection rate ≤30 days of implantation was 8.6% for primary HeRO implantation and 2.3% for staged implantations (P = .12). The rates of early bacteremia and HeRO resection requiring surgical resection were not significantly different between groups (P = .19 and P = .065, respectively), nor were age, gender, laterality, anastomosis to an existing arteriovenous access, human immunodeficiency virus status, diabetes, steroids, chemotherapy, body mass index, or graft location. None of the patient variables, techniques, or graft-related variables correlated significantly with the early infection rate. The staged HeRO implantation strategy did not result in an increased early infection risk compared with conventional primary implantation and is thus a reasonable strategy for HeRO insertion in hemodialysis patients

  17. Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients

    NARCIS (Netherlands)

    Veeneman, JM; Kingma, HA; Boer, TS; Stellaard, F; De Jong, PE; Reijngoud, DJ; Huisman, RM

    Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-nriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD)

  18. Patient education and care for peritoneal dialysis catheter placement: a quality improvement study.

    Science.gov (United States)

    Wong, Leslie P; Yamamoto, Kalani T; Reddy, Vijay; Cobb, Denise; Chamberlin, Alice; Pham, Hien; Sun, Sumi J; Mallareddy, Madhavi; Saldivar, Miguel

    2014-01-01

    Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue. ♢ A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications. ♢ Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheter-related problems. ♢ There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs.

  19. Serum Soluble (Pro)Renin Receptor Levels in Maintenance Hemodialysis Patients.

    Science.gov (United States)

    Amari, Yoshifumi; Morimoto, Satoshi; Nakajima, Fumitaka; Ando, Takashi; Ichihara, Atsuhiro

    2016-01-01

    The (pro)renin receptor [(P)RR] is cleaved by furin to generate soluble (P)RR [s(P)RR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis patients have advanced atherosclerosis. The aim of this study was to investigate the relationships between serum s(P)RR levels and background factors, including indices of atherosclerosis, in hemodialysis patients. Serum s(P)RR levels were measured in hemodialysis patients and clearance of s(P)RR through the membrane of the dialyzer was examined. Furthermore, relationships between serum s(P)RR levels and background factors were assessed. Serum s(P)RR levels were significantly higher in hemodialysis patients (30.4 ± 6.1 ng/ml, n = 258) than those in subjects with normal renal function (21.4 ± 6.2 ng/ml, n = 39, P ankle-brachial index (ABI) of hemodialysis patients when compared with subjects with normal renal function, although s(P)RR is dialyzed to some extent, but to a lesser extent than creatinine. High serum s(P)RR levels may be associated with atherosclerosis independent of other risk factors, suggesting that serum s(P)RR could be used as a marker for atherosclerotic conditions in hemodialysis patients.

  20. Attention and information processing in end stage renal disease and effect of hemodialysis: a bedside study.

    Science.gov (United States)

    Dixit, Abhinav; Dhawan, Sanjay; Raizada, Alpana; Yadav, Anil; Vaney, Neelam; Kalra, Om Prakash

    2013-10-01

    The neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products.

  1. Tuberculosis in children undergoing hemodialysis

    Directory of Open Access Journals (Sweden)

    Gargah Tahar

    2010-04-01

    Full Text Available Gargah Tahar1, Goucha-Louzir Rim2, Lakhoua Mohamed Rachid11Department of Pediatric Nephrology, 2Department of Nephrology, Charles Nicolle Hospital, Tunis, TunisiaAbstract: Tuberculosis (TB remains a public health problem in Tunisia. Its incidence is higher in immunocompromised hosts than in the general population. In children and during hemodialysis, TB is characterized by the frequency of extrapulmonary localizations and diagnostic difficulties. The aim of this retrospective study is to evaluate the incidence of TB in Tunisian children undergoing hemodialysis and to determine its clinical features as well as the results of chemotherapy.Method: This retrospective study includes seven TB children among 112 children on hemodialysis at the pediatric nephrology department in Charles Nicolle Hospital from 2002 to 2008. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological, and histological examinations. Treatment with anti-TB drugs, the results of therapy, and the outcome of patients were noted.Results: There were four girls and three boys aged 10 to 16 years (mean, 13 years. They had been on hemodialysis for 2 to 5 years (mean, 3 years. Noted clinical features were weight loss and fever in five cases, chest pain in one case, cervical lymph node in one case, and spinal pain in one case. The organ systems involved were pleural in two cases, pulmonary in one case, peritoneal in one case, cervical lymphatic in one case, and spinal in one case. One patient was treated empirically with a good response. Diagnosis was made by isolation of mycobacterium TB in three cases, by specific histological signs observed in a lymph node biopsy in one case, in peritoneal biopsy in one case, and in discovertebral biopsy in one case. In the remaining patient, the clinical and radiological presentations were compatible with pulmonary TB. All patients received four anti-TB drugs: isoniazid, rifampicin, pyrazinamide

  2. Hemodialysis outcomes in a global sample of children and young adult hemodialysis patients: the PICCOLO MONDO cohort.

    Science.gov (United States)

    Ferris, Maria; Gibson, Keisha; Plattner, Brett; Gipson, Debbie S; Kotanko, Peter; Marcelli, Daniele; Marelli, Cristina; Etter, Michael; Carioni, Paola; von Gersdorff, Gero; Xu, Xiaoqi; Kooman, Jeroen P; Xiao, Qingqing; van der Sande, Frank M; Power, Albert; Picoits-Filho, Roberto; Sylvestre, Lucimary; Westreich, Katherine; Usvyat, Len

    2016-04-01

    The aim of this study was to describe the experience of pediatric and young adult hemodialysis (HD) patients from a global cohort. The Pediatric Investigation and Close Collaborative Consortium for Ongoing Life Outcomes for MONitoring Dialysis Outcomes (PICCOLO MONDO) study provided de-identified electronic information of 3244 patients, ages 0-30 years from 2000 to 2012 in four regions: Asia, Europe, North America and South America. The study sample was categorized into pediatric (≤18 years old) and young adult (19-30 years old) groups based on the age at dialysis initiation. For those with known end-stage renal disease etiology, glomerular disease was the most common diagnosis in children and young adults. Using Europe as a reference group, North America [odds ratio (OR) 2.69; CI 1.29, 5.63] and South America (OR 4.21; CI 2.32, 7.63) had the greatest mortality among young adults. North America also had higher rates of overweight, obesity, hypertension, cardiovascular disease, hospitalizations and secondary diabetes compared with all other regions. Initial catheter use was greater for North American (86.4% in pediatric patients and 75.2% in young adults) and South America (80.6% in pediatric patients and 75.9% in young adults). Catheter use at 1-year follow-up was most common in North American children (77.3%) and young adults (62.9%). Asia had the lowest rate of catheter use. For both age groups, dialysis adequacy (equilibrated Kt/V) ranged between 1.4 and 1.5. In Asia, patients in both age groups had significantly longer treatment times than in any other region. The PICCOLO MONDO study has provided unique baseline and 1-year follow-up information on children and young adults receiving HD around the globe. This cohort has brought to light aspects of care in these age groups that warrant further investigation.

  3. Urea biosensor for hemodialysis monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Glass, Robert S. (Livermore, CA)

    1999-01-01

    An electrochemical sensor capable of detecting and quantifying urea in fluids resulting from hemodialysis procedures. The sensor is based upon measurement of the pH change produced in an aqueous environment by the products of the enzyme-catalyzed hydrolysis of urea. The sensor may be fabricated using methods amenable to mass fabrication, resulting in low-cost sensors and thus providing the potential for disposable use. In a typical application, the sensor could be used in treatment centers, in conjunction with an appropriate electronics/computer system, in order to determine the hemodialysis endpoint. The sensor can also be utilized to allow at-home testing to determine if dialysis was necessary. Such a home monitor is similar, in principle, to devices used for blood glucose testing by diabetics, and would require a blood droplet sample by using a finger prick.

  4. Urea biosensor for hemodialysis monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Glass, R.S.

    1999-01-12

    This research discloses an electrochemical sensor capable of detecting and quantifying urea in fluids resulting from hemodialysis procedures. The sensor is based upon measurement of the pH change produced in an aqueous environment by the products of the enzyme-catalyzed hydrolysis of urea. The sensor may be fabricated using methods amenable to mass fabrication, resulting in low-cost sensors and thus providing the potential for disposable use. In a typical application, the sensor could be used in treatment centers, in conjunction with an appropriate electronics/computer system, in order to determine the hemodialysis endpoint. The sensor can also be utilized to allow at-home testing to determine if dialysis was necessary. Such a home monitor is similar, in principle, to devices used for blood glucose testing by diabetics, and would require a blood droplet sample by using a finger prick. 9 figs.

  5. Successful management of a broken epidural catheter!!!

    Science.gov (United States)

    Hippalgaonkar, Amruta Vinod; Kudalkar, Amala G; Gaikwad, Smita M; Modak, Shailendra; Gupta, Hema B; Tendolkar, Bharati A

    2017-01-01

    Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.

  6. Successful management of a broken epidural catheter!!!

    Directory of Open Access Journals (Sweden)

    Amruta Vinod Hippalgaonkar

    2017-01-01

    Full Text Available Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.

  7. Colonization of peripheral intravascular catheters with biofilm ...

    African Journals Online (AJOL)

    Background: Biofilms often colonize catheters and contribute to catheter-related septicemia. However, predictors of catheter colonization by biofilms remain poorly defined. The aim of this study was to evaluate clinical factors that may be associated with biofilm colonization of catheters. Materials and Methods: A total of 54 ...

  8. Correlates of ADL difficulty in a large hemodialysis cohort

    OpenAIRE

    Kutner, Nancy G.; Zhang, Rebecca; Allman, Richard M.; Bowling, C. Barrett

    2013-01-01

    Needing assistance with activities of daily living (ADL) is an early indicator of functional decline and has important implications for individuals’ quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis (HD). A multi-center cohort of 742 prevalent HD patients was assessed 2009–2011 and classified as frail, pre-frail and non-frail by the Fried frailty index (recent unintentional weight loss, reported e...

  9. Genistein Modified Polymer Blends for Hemodialysis Membranes

    Science.gov (United States)

    Chang, Teng; Kyu, Thein; Define, Linda; Alexander, Thomas

    2012-02-01

    A soybean-derived phytochemical called genistein was used as a modifying agent to polyether sulfone/polyvinyl pyrrolidone (PES/PVP) blends to produce multi-functional hemodialysis membranes. With the aid of phase diagrams of PES/PVP/genistein blends, asymmetric porous membranes were fabricated by coagulating in non-solvent. Both unmodified and genistein modified PES/PVP membranes were shown to be non-cytotoxic to the blood cells. Unmodified PES/PVP membranes were found to reduce reactive oxygen species (ROS) levels, whereas the genistein modified membranes exhibited suppression for ˜60% of the ROS levels. Also, the genistein modified membranes revealed significant suppression of pro-inflammatory cytokines: IL-1β, IL-6, and TNF-α. Moreover, addition of PVP to PES showed the reduced trend of platelet adhesion and then leveled off. However, the modified membranes exhibited suppression of platelet adhesion at low genistein loading, but beyond 15 wt%, the platelet adhesion level rised up.

  10. DNA methylation: hemodialysis versus hemodiafiltration.

    Science.gov (United States)

    Ghigolea, Adrian-Bogdan; Moldovan, Raluca Argentina; Gherman-Caprioara, Mirela

    2015-04-01

    Aberrant DNA methylation is an emerging characteristic of chronic kidney disease including dialysis patients. It appears to be associated to inflammation. We compared the global DNA methylation status in 10 control subjects compared to 80 dialysis patients (N = 40 on-line hemodiafiltration, N = 40 high-flux hemodialysis) in relation to the dialysis technique and inflammation. Whole blood DNA methylation was assessed with a 5-mc DNA enzyme linked immunosorbent assay Kit. Global DNA methylation was higher in hemodialysis (HD) compared to on-line hemodiafiltration (HDF) patients (0.045 vs. 0.039; P patients according to the median value of 5-mC. DNA methylation was highest in inflamed patients on hemodialysis. The dialysis technique was the only independent predictor of global DNA methylation in dialysis patients. On-line HDF could be associated with a favorable DNA methylation profile. © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

  11. A unique case of pulmonary artery catheter bleeding from the oximetry connection port

    Directory of Open Access Journals (Sweden)

    Suman Rajagopalan

    2014-12-01

    Full Text Available Pulmonary artery catheter is an invasive monitor usually placed in high-risk cardiac surgical patients to optimize the cardiac functions. We present this case of blood oozing from the oximetry connection port of the pulmonary artery catheter that resulted in the inability to monitor continuous cardiac output requiring replacement of the catheter. The cause of this abnormal bleeding was later confirmed to be due to a manufacturing defect.

  12. 21 CFR 876.5860 - High permeability hemodialysis system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false High permeability hemodialysis system. 876.5860... hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device intended for use... toxemic conditions by performing such therapies as hemodialysis, hemofiltration, hemoconcentration, and...

  13. Costs and Outcomes in Hemodialysis and Hemodiafiltration

    NARCIS (Netherlands)

    Mazairac, A.H.A.

    2011-01-01

    Both survival and quality of life (QoL) are poor in patients on hemodialysis. Earlier studies have shown their QoL to be lower than in patients with for instance chronic heart failure, arthritis and metastatic colon cancer. Hemodialysis patients do not only face the symptoms of end-stage renal

  14. Shorter dialysis session length was not associated with lower mental health and physical functioning in elderly hemodialysis patients: Results from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS).

    Science.gov (United States)

    Kitagawa, Masashi; Sada, Ken-Ei; Hinamoto, Norikazu; Kimachi, Miho; Yamamoto, Yosuke; Onishi, Yoshihiro; Fukuhara, Shunichi

    2017-01-01

    Health-related quality of life (HRQOL) is often prioritized over long-term survival in elderly patients. Although a longer dialysis session length (DSL) has been shown to reduce mortality, its effects on improving the HRQOL are unknown. Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), patients aged ≥ 65 years on maintenance hemodialysis were enrolled. DSL was categorized as short (240 minutes). The primary outcomes were changes in mental health (ΔMH) and physical functioning (ΔPF) scores assessed using the Japanese version of SF-12, in one year. The differences in the ΔMH and ΔPF among the three groups were assessed via regression (beta) coefficients derived using a linear regression model. Of 1,187 patients at baseline, 319 (26.9%) had a short length, 686 (57.8%) a medium length, and 182 (15.3%) a long length. We assessed the ΔMH data from 793 patients and the ΔPF data from 738. No significant differences in the ΔMH were noted for the short or long groups compared with the medium group (score difference: 0.26, 95% confidence interval [CI]: -4.17 to 4.69 for short; score difference: -1.15, 95% CI: -6.17 to 3.86 for long). Similarly, no significant differences were noted for these groups versus the medium group in ΔPF either (score difference: -1.43, 95% CI: -6.73 to 3.87 for short; score difference: -1.71, 95% CI: -7.63 to 4.22 for long). A shorter DSL might have no adverse effects on MH or PF for elderly patients.

  15. Shorter dialysis session length was not associated with lower mental health and physical functioning in elderly hemodialysis patients: Results from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS.

    Directory of Open Access Journals (Sweden)

    Masashi Kitagawa

    Full Text Available Health-related quality of life (HRQOL is often prioritized over long-term survival in elderly patients. Although a longer dialysis session length (DSL has been shown to reduce mortality, its effects on improving the HRQOL are unknown.Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS, patients aged ≥ 65 years on maintenance hemodialysis were enrolled. DSL was categorized as short (240 minutes. The primary outcomes were changes in mental health (ΔMH and physical functioning (ΔPF scores assessed using the Japanese version of SF-12, in one year. The differences in the ΔMH and ΔPF among the three groups were assessed via regression (beta coefficients derived using a linear regression model.Of 1,187 patients at baseline, 319 (26.9% had a short length, 686 (57.8% a medium length, and 182 (15.3% a long length. We assessed the ΔMH data from 793 patients and the ΔPF data from 738. No significant differences in the ΔMH were noted for the short or long groups compared with the medium group (score difference: 0.26, 95% confidence interval [CI]: -4.17 to 4.69 for short; score difference: -1.15, 95% CI: -6.17 to 3.86 for long. Similarly, no significant differences were noted for these groups versus the medium group in ΔPF either (score difference: -1.43, 95% CI: -6.73 to 3.87 for short; score difference: -1.71, 95% CI: -7.63 to 4.22 for long.A shorter DSL might have no adverse effects on MH or PF for elderly patients.

  16. Peritoneal catheters and exit-site practices toward optimum peritoneal access: a review of current developments.

    Science.gov (United States)

    Flanigan, Michael; Gokal, Ram

    2005-01-01

    This review updates the 1998 International Society for Peritoneal Dialysis (ISPD) recommendations for peritoneal dialysis catheters and exit-site practices (Gokal R, et al. Peritoneal catheters and exit-site practices toward optimum peritonealaccess: 1998 update. Perit Dial Int 1998; 18:11-33.) The Ovid and PubMed search engines were used to review the Medline databases of January 1980 through June 2003. Searches were restricted to human data; primary key word searches included dialysis, peritoneal dialysis, and continuous ambulatory peritoneal dialysis cross referenced with access, catheter, dialysis catheter, peritoneal dialysis catheter, and Tenckhoff catheter. Related searches were provided via the PubMed related articles link. Reports were selected if they provided identifiable information on catheter design, catheter placement technique, and survival or placement complications. Reports without such data were excluded from review. Each study was then categorized by its characteristics: single-center or multicenter; retrospective or prospective; controlled trial, with or without random patient assignment; or review article. There are few randomized controlled evaluations testing how catheter design and/or placement influence long-term survival and function, and these are typically conducted at a single center. The majority of reports represent retrospective single-center experiences, and these are supplemented by occasional multicenter data registries. There is substantial variability in catheter outcomes between centers, and this variability is more closely correlated with operator and center characteristics than with catheter design. Some catheter designs appear to impact long-term catheter success, and, in some cases, specific patient characteristics and dialysis formats combine with specific catheter designs to influence catheter survival. Most reporters prefer two-cuff designs and placement of the deep cuff at an intramuscular location. Intramuscular cuff

  17. Catheter associated urinary tract infections

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    Nicolle, Lindsay E

    2014-01-01

    Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributab...

  18. Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

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    Silva BC

    2016-04-01

    Full Text Available Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC to tunneled-cuffed catheters (TCCs for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008 and B (from 2013 to 2015. Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P<0.0001. Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092. Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan–Meier model (log-rank = 0.188. TCC removal for low blood flow occurred in 8.9% of procedures. Conclusion: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic. Keywords: renal dialysis, tunneled catheters, interventional nephrology

  19. Avaliação da capacidade funcional e da qualidade de vida em pacientes renais crônicos submetidos a tratamento hemodialítico Assessment of functional capacity and quality of life in chronic renal patients under hemodialysis treatment

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    Marina Stela Cunha

    2009-06-01

    Full Text Available Este estudo visou avaliar a capacidade funcional e a qualidade de vida em pacientes com incapacidade renal crônica (IRC submetidos a tratamento hemodialítico e verificar possíveis correlações entre essas variáveis clínicas e idade, índice de massa corpórea (IMC e tempo de hemodiálise. Dezesseis pacientes com IRC foram submetidos à avaliação da capacidade funcional pelo teste de caminhada de seis minutos (TC6', mensuração das pressões inspiratória e expiratória máxima, e pela aplicação da escala de severidade da fadiga. Também responderam ao questionário SF-36, sobre qualidade de vida relacionada à saúde (QV. A capacidade funcional mostrou-se abaixo dos valores preditos no TC6' e na força dos músculos respiratórios (principalmente expiratórios; e todos apresentaram em média fadiga leve. Pacientes com mais de 60 anos e aqueles com menor tempo de hemodiálise apresentaram baixa capacidade funcional apenas quanto à distância caminhada, sem prejuízo das demais funções. O IMC não interferiu na capacidade funcional. O escore médio no SF-36 foi 72,3; dor e prejuízo na vitalidade foram indicados como os itens que mais interferem em sua QV, tendo os fatores idade, índice de massa corporal e tempo de hemodiálise não se mostrado relevantes na maioria dos domínios avaliados pelo SF-36. Os resultados sugerem que, com pouca interferência da idade e do tempo de hemodiálise, pacientes com IRC submetidos a tratamento hemodialítico apresentam prejuízos na capacidade funcional e na QV.This study aimed at evaluating the functional capacity and health-related quality of life in chronic renal insufficiency (CRI patients undergoing hemodialysis treatment, also checking possible correlations between these clinical variables and age, body mass index (BMI, and hemodialysis time. Sixteen patients were submitted to functional capacity assessment by means of the six-minute walk test (6WT, measures of maximal inspiratory and

  20. Correlates of ADL difficulty in a large hemodialysis cohort.

    Science.gov (United States)

    Kutner, Nancy G; Zhang, Rebecca; Allman, Richard M; Bowling, C Barrett

    2014-01-01

    Needing assistance with activities of daily living (ADL) is an early indicator of functional decline and has important implications for individuals' quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis (HD). A multicenter cohort of 742 prevalent HD patients was assessed in 2009-2011 and classified as frail, prefrail and nonfrail by the Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity). Patients reported need for assistance with 4 ADL tasks and identified contributing symptoms/conditions (pain, balance, endurance, weakness, others). Nearly 1 in 5 patients needed assistance with 1 or more ADL. Multivariable analysis showed increased odds for needing ADL assistance among frail (odds ratio [OR] 11.35; 95% confidence interval [CI] 5.50-23.41; P Hemodialysis.

  1. Current practice of conventional intermittent hemodialysis for acute kidney injury

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    H Schiffl

    2013-01-01

    Full Text Available The use of conventional intermittent hemodialysis (IHD represents a mainstay of supportive care of patients with acute kidney injury (AKI. However, a number of fundamental questions regarding the optimal management of IHD remain unanswered after more than six decades of renal replacement therapy (RRT. This review summarizes current evidence regarding the timing of initiation of intermittent hemodialysis, the comparative outcomes (mortality and recovery of renal function, the prescription of the intensity of this therapy and discontinuation of dialysis. The way conventional IHD is performed has an impact on the outcome of sick patients with AKI. The value of regular education and training of those who provide IHD cannot be emphasized enough. However, we must be realistic in our expectations that no mode of RRT per se will substantially alter the excessive mortality of critically ill-patients with AKI.

  2. Investigation of biofilm formation on a charged intravenous catheter relative to that on a similar but uncharged catheter

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    Richards GA

    2014-06-01

    Full Text Available Guy A Richards,1,2 Adrian J Brink,3 Ross McIntosh,4 Helen C Steel,5,6 Riana Cockeran5,61Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, 2Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Department of Clinical Microbiology, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa; 4Nano-Scale Transport Physics Laboratory, School of Physics, University of the Witwatersrand, Johannesburg, South Africa; 5Medical Research Council Unit for Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa; 6National Health Laboratory Service, Pretoria, South AfricaAbstract: Catheter-related blood stream infections increase morbidity, mortality, and costs. This study investigated whether Certofix® protect antimicrobial catheters carry a surface charge and whether this inhibits biofilm formation. The capacitance of the catheter surfaces was measured and, to determine if the catheters released ions, distilled water was passed through and current measured as a function of voltage. With probes touching the inner and outer surfaces, capacitance was not voltage-dependent, indicating surfaces were uncharged or carried a similar charge. When one probe penetrated the catheter wall, capacitance was weakly voltage-dependent, indicating the presence of a surface charge. Standard and charged catheters were also exposed to phosphate buffered saline as controls or 2×106 colony forming units/mL (in phosphate buffered saline of six different microorganisms for 60 or 120 minutes. When the growth of detached bacteria was measured, biofilm formation was significantly reduced, (P<0.05, for charged catheters for all organisms.Keywords: central venous catheters, electrical charge, biofilm

  3. Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

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    Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul [College of Medicine, Soonchunhyang Univ., Chonan (Korea, Republic of)

    2002-04-01

    To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.

  4. Physiopathological approach to infective endocarditis in chronic hemodialysis patients: left heart versus right heart involvement.

    Science.gov (United States)

    Bentata, Yassamine

    2017-11-01

    Infectious endocarditis (IE), a complication that is both cardiac and infectious, occurs frequently and is associated with a heavy burden of morbidity and mortality in chronic hemodialysis patients (CHD). About 2-6% of chronic hemodialysis patients develop IE and the incidence is 50-60 times higher among CHD patients than in the general population. The left heart is the most frequent location of IE in CHD and the different published series report a prevalence of left valve involvement varying from 80% to 100%. Valvular and perivalvular abnormalities, alteration of the immune system, and bacteremia associated with repeated manipulation of the vascular access, particularly central venous catheters, comprise the main factors explaining the left heart IE in CHD patients. While left-sided IE develops in altered valves in a high-pressure system, right-sided IE on the contrary, generally develops in healthy valves in a low-pressure system. Right-sided IE is rare, with its incidence varying from 0% to 26% depending on the study, and the tricuspid valve is the main location. Might the massive influx of pathogenic and virulent germs via the central venous catheter to the right heart, with the tricuspid being the first contact valve, have a role in the physiopathology of IE in CHD, thus facilitating bacterial adhesion? While the physiopathology of left-sided IE entails multiple and convincing mechanisms, it is not the case for right-sided IE, for which the physiopathological mechanism is only partially understood and remains shrouded in mystery.

  5. Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

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    Silvia Eduara Kennerly de Albuquerque

    2014-05-01

    Full Text Available Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI. Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI or local access infections (LAI. Our study aimed to provide a wide overview of HAI epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC, either temporary (RR = 13.35, 95% CI = 6.68–26.95 or permanent (RR = 2.10, 95% CI = 1.09–4.13, as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units.

  6. Novel Bone-Anchored Vascular Access on the Mastoid for Hemodialysis: Concept and Preclinical Trials.

    Science.gov (United States)

    Stieger, Christof; Arnold, Andreas; Kruse, Anja; Wiedmer, Simona; Widmer, Matthias; Guignard, Jeremie; Schutz, Daniel; Guenat, Jean-Marc; Bachtler, Matthias; Caversaccio, Marco; Uehlinger, Dominik E; Frey, Felix J; Hausler, Rudolf

    2016-05-01

    We present the development of a bone-anchored port for the painless long-term hemodialytic treatment of patients with renal failure. This port is implanted behind the ear. The port was developed based on knowledge obtained from long-term experience with implantable hearing devices, which are firmly anchored to the bone behind the ear. This concept of bone anchoring was adapted to the requirements for a vascular access during hemodialysis. The investigational device is comprised of a base plate that is firmly fixed with bone screws to the bone behind the ear (temporal bone). A catheter leads from the base plate valve block through the internal jugular vein and into the right atrium. The valves are opened using a special disposable adapter, without any need to puncture the blood vessels. Between hemodialysis sessions, the port is protected with a disposable cover. Flow rate, leak tightness, and purification were tested on mockups. Preoperative planning and the surgical procedure were verified in 15 anatomical human whole head specimens. Preclinical evaluations demonstrated the technical feasibility and safety of the investigational device. Approximately 1.5 million people are treated with hemodialysis worldwide, and 25% of the overall cost of dialysis therapy results from vascular access problems. New approaches toward enhancing vascular access could potentially reduce the costs and complications of hemodialytic therapy.

  7. Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Silvia Eduara Kennerly de Albuquerque

    Full Text Available Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI. Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI or local access infections (LAI. Our study aimed to provide a wide overview of HAI epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC, either temporary (RR = 13.35, 95% CI = 6.68-26.95 or permanent (RR = 2.10, 95% CI = 1.09-4.13, as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units.

  8. Implantation of a new access device for hemodialysis (Dialock): initial experience in 5 patients

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    Schmitz-Rode, T.; Buecker, A.; Tacke, J.; Wingen, M.; Guenther, R.W. [Dept. of Diagnostic Radiology, Universitaetsklinikum der RWTH Aachen (Germany); Noah, M. [Dept. of Plastic Surgery, Universitaetsklinikum der RWTH Aachen (Germany); Ketteler, M. [Dept. of Nephrology, Universitaetsklinikum der RWTH Aachen (Germany)

    2001-06-01

    A new hemodialysis access port system was implanted. Methods: The Dialock{sup TM} consists of a port-like double-valve, implanted subcutaneously below the clavicle, which is attached to two catheters, placed in the right atrium via the jugular vein. The device has been implanted in 5 patients (4 female, 1 male). Results: In all 5 patients the implantation of the catheters and the port was technically successful. Total average duration of dialysis was 3.6 months. Two patients developed a port pocket hematoma 10-14 days post implantation, one of them required surgical revision. One port was explanted due to septicemia, whereas a port infection was not confirmed. One patient showed a thrombotic occlusion of both catheter tips 8 days after implantation, fixed by catheter exchange. Another patient presented with slight migration of the port catheters, which was managed by refixation of the port within the pocket. Beside these complications, the devices were working well. Conclusion: The Dialock system offers an interesting alternative to external catheters for hemodialysis. With respect to the complications it deserves further studies to determine its future role in the field of vascular access. (orig.) [German] Ein neues Haemodialyse-Portsystem wurde klinisch erprobt. Methoden: Das Dialock{sup TM}-System besteht aus einem Doppelventil-Port, der subkutan unterhalb der Klavikel implantiert wird. An den Port sind zwei Katheter angeschlossen, die subkutan getunnelt transjugulaer im rechten Vorhof platziert werden. Das System wurde in 5 Patienten implantiert (4 Frauen, 1 Mann). Ergebnisse: Bei allen 5 Patienten war die Katheter- und Portimplantation technisch erfolgreich. Die bisherige mittlere Dialyse-Dauer betraegt 3,6 Monate. Bei zwei Patienten bildete sich ein Haematom der Porttasche 10-14 Tage nach der Implantation. In einem Fall war eine operative Ausraeumung erforderlich. Ein Patient entwickelte eine Sepsis, worauf das Portsystem explantiert wurde. Eine Portinfektion

  9. Removal of Peripheral Intravenous Catheters Due to Catheter Failures Among Adult Patients.

    Science.gov (United States)

    Murayama, Ryoko; Uchida, Miho; Oe, Makoto; Takahashi, Toshiaki; Oya, Maiko; Komiyama, Chieko; Sanada, Hiromi

    This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.

  10. Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees.

    Science.gov (United States)

    Fülöp, Tibor; Tapolyai, Mihály B; Agarwal, Mohit; Lopez-Ruiz, Arnaldo; Molnar, Miklos Z; Dossabhoy, Neville R

    2017-09-01

    Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections. Waiting for assistance from surgical or radiological services-which may not be available in all hospitals-may result in delays in services and potential harm to the patients. Imparting and maintaining procedural skills to remove infected TDC may be very valuable for training programs in clinical nephrology. In this article the current literature on bedside TDC removal, including potential anticipated complications during removal, are reviewed. To date, the authors have documented successful implementation of bedside TDC removal in training programs from two different settings, including both in- and outpatients and with trainee involvement. In summary, training general nephrologists for bedside TDC removal will afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient setting. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction: Prevalence, Patient and Dialysis Treatment-Related Factors, and Prognostic Significance

    Science.gov (United States)

    Assa, Solmaz; Hummel, Yoran M.; Voors, Adriaan A.; Kuipers, Johanna; Westerhuis, Ralf; de Jong, Paul E.

    2012-01-01

    Summary Background and objectives The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Design, setting, participants, & measurements Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments. Results Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid–base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index. Conclusions Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid–base parameters. PMID

  12. Are the effects of hemodialysis on ocular parameters similar during and after a hemodialysis session?

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    Ahmet Elbay

    Full Text Available ABSTRACT Purpose: To evaluate the changes in several ocular parameters, including choroidal thickness, during and after hemodialysis. Methods: Twenty-seven eyes of 27 patients with chronic renal failure undergoing hemodialysis were included. The patients underwent an ophthalmic examination, including intraocular pressure, central corneal thickness, iridocorneal angle, subfoveal choroidal thickness, and blood pressure, just before a hemodialysis session, during the second hour of the session, and half an hour after the end of the session. Body weight was measured before and after the session, and ultrafiltration volume was noted after the session. Central corneal thickness, intraocular pressure, and subfoveal choroidal thickness were measured by optical coherence tomography. Results: In comparison with baseline levels, mean intraocular pressure and central corneal thickness increased significantly during the second hour of hemodialysis (p=0.001 and p=0.011, respectively and showed no significant changes after hemodialysis (p=0.844 and p=0.246, respectively. Mean iridocorneal angle did not significantly change during the second hour of hemodialysis (p=0.101 and after hemodialysis (p=0.589. Mean subfoveal choroidal thickness was significantly lower during the second hour of hemodialysis (p<0.001 and after hemodialysis (p<0.001. Conclusions: Mean intraocular pressure and central corneal thickness increased and subfoveal choroidal thickness decreased during the second half of the hemodialysis session. During the second half of the session, intraocular pressure and central corneal thickness had a trend toward reduction, while subfoveal choroidal thickness had a relatively steady course. Because of possible fluctuations in the values, it would be reasonable to evaluate the changes not only from before to after hemodialysis but also during hemodialysis when analyzing the ocular effects of dialysis.

  13. Prognostic indicators and patterns of renal recovery in patients requiring hemodialysis for acute kidney injury

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    Vaddadi Suresh, Usha Bhargavi E, N.S.R.C Guptha, Vinod L, Vijay Kumar P, Ravinder P

    2014-03-01

    Full Text Available Background: The outcome of patients with acute kidney injury (AKI is highly variable. Patients who receive renal replacement therapy (RRT for similar diseases may recover differently. The factors that operate in each patient may alter the prognosis and outcome. Aims: Our study aims at identification of prognostic factors influencing recovery in patients who required hemodialysis for AKI. Material and Methods: Patients admitted in different ICUs with AKI who underwent hemodialysis in a tertiary care hospital over a three year period were included in the study. Time from day one of disease to first dialysis, hematological and biochemical parameters were noted. Patients were grouped based on the time taken for recovery of renal function following hemodialysis into group A (2 weeks. Studied parameters have been statistically analyzed to find any significant association with recovery time. Results: Out of 63 patients, 9 progressed to chronic kidney disease. In the remaining 54, Group A comprised 31 and group B 23. Out of all the factors studied, serum creatinine (7.0±1.3 vs 8.4±3.8; P=0.018, S. bicarbonate (21.7±2.8 vs 19.7±3.8; P=0.03, pH at admission (7.25±0.13 vs 7.1±0.19; P=0.048; number of hemodialysis sessions (3.5 ±1.5 vs 5±2.4; P=0.016 and time lag from day one of disease to first hemodialysis (8.6 ± 3.6 vs 11.5±5.9; P=0.007 showed significant association with recovery time. Conclusion: Recovery following AKI is influenced by factors liked delayed presentation, late initiation of hemodialysis, low pH and low bicarbonate which can predict delayed renal recovery following hemodialysis.

  14. Ultrasound localization of the femoral vein facilitates successful cannulation for hemodialysis

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    King-Kwan Lam

    2013-10-01

    Full Text Available Background: Real-time ultrasound-guided techniques allow for improved cannulation of the internal jugular vein and femoral vein for hemodialysis; however, these techniques require extra sterilization procedures, specialized probes, or needle guides. A simpler ultrasound vessel localization method was performed to investigate whether this alternative approach would aid in the cannulation of the femoral vein for patients in whom temporary angioaccess was required for hemodialysis. Methods: Patients requiring temporary femoral vein catheters for hemodialysis were divided into 2 groups on alternating days of the week during a 6-month period. One group underwent ultrasound localization of the femoral vein before cannulation and the second group received conventional landmark localization. Data regarding the strength of the femoral arterial pulse, number of attempts, failures, and complications were recorded. Results: Ultrasound localization resulted in significantly improved first-attempt success rates, reduced attempts, and reduced failure and complication rates overall (p < 0.001, p < 0.001, p = 0.002 and p = 0.004 respectively as well as in the group of patients with a clearly discernible arterial pulse (p < 0.001, p = 0.001, p = 0.004 and p = 0.011 respectively. The same trend was observed among patients with faintly palpable or non-palpable femoral arterial pulses, although the differences were not statistically significant. Conclusion: Cannulation of the femoral vein for hemodialysis should be performed with the aid of ultrasound. If real-time ultrasound-guided cannulation is not available, the vessel localization method is a good alternative, given its known limitations and the fact that it is simpler. It remains to be determined whether 1 - dimensional localization or localization including vessel depth information can improve outcomes in patients with faintly palpable or non-palpable femoral arterial pulses.

  15. CONTRIBUTION OF COGNITIVE INTERFERENCE TO DECREMENTS IN WALKING PERFORMANCE IN HEMODIALYSIS PATIENTS

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    Ken Wilund

    2012-06-01

    These data indicate that walking impairments in hemodialysis patients are not due exclusively to declines in physical function, but that cognitive-motor interference also plays a significant role. This has significant clinical importance, as therapies designed to improve walking performance and physical function, such as nutritional and exercise interventions, may need to be augmented with cognitive training in order to have maximum benefits.

  16. Hemodialysis Arteriovenous Fistula Patency Revisited: Results of a Prospective, Multicenter Initiative

    OpenAIRE

    Huijbregts, Henricus J.T.; Bots, Michiel L.; Wittens, Cees H A; Schrama, Yvonne C.; Moll, Frans L.; Blankestijn, Peter J.

    2008-01-01

    Background and objectives: Vascular access standards are predominantly based on older, single-center reports; however, the hemodialysis population has changed dramatically and primary arteriovenous fistula failure is a huge problem. This prospective, multicenter study used standardized definitions to analyze patency rates and potential risk factors that affect functional patency and late arteriovenous fistula functionality.

  17. Hypernatremia: Correction Rate and Hemodialysis

    Directory of Open Access Journals (Sweden)

    Saima Nur

    2014-01-01

    Full Text Available Severe hypernatremia is defined as serum sodium levels above 152 mEq/L, with a mortality rate ≥60%. 85-year-old gentleman was brought to the emergency room with altered level of consciousness after refusing to eat for a week at a skilled nursing facility. On admission patient was nonverbal with stable vital signs and was responsive only to painful stimuli. Laboratory evaluation was significant for serum sodium of 188 mmol/L and water deficit of 12.0 L. Patient was admitted to medicine intensive care unit and after inadequate response to suboptimal fluid repletion, hemodialysis was used to correct hypernatremia. Within the first fourteen hours, sodium concentration only changed 1 mEq/L with a fluid repletion; however, the concentration dropped greater than 20 mEq/L within two hours during hemodialysis. Despite such a drastic drop in sodium concentration, patient did not develop any neurological sequela and was at baseline mental status at the time of discharge.

  18. Anterior chamber depth during hemodialysis

    Directory of Open Access Journals (Sweden)

    Gracitelli CPB

    2013-08-01

    Full Text Available Carolina Pelegrini Barbosa Gracitelli,1 Francisco Rosa Stefanini,1 Fernando Penha,1 Miguel Ângelo Góes,2 Sérgio Antonio Draibe,2 Maria Eugênia Canziani,2 Augusto Paranhos Junior1 1Ophthalmology Department, 2Division of Nephrology, Federal University of São Paulo – UNIFESP, São Paulo, Brazil Background: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD because of anterior chamber depth changes during this therapy. Purpose: To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results: There was no difference in the axial length between the three measurements (P = 0.241. We observed a significantly decreased anterior chamber depth (P = 0.002 during HD sessions. Conclusion: Our results support the idea that there is a change in anterior chamber depth in HD sessions. Keywords: anterior chamber, hemodialysis, axial length, acute angle-closure glaucoma

  19. Automated Pointing of Cardiac Imaging Catheters

    OpenAIRE

    Loschak, Paul; Brattain, Laura; Howe, Robert D.

    2013-01-01

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translati...

  20. Intradialytic Exercise Programs for Hemodialysis Patients

    National Research Council Canada - National Science Library

    Jung, Tae-Du; Park, Sun-Hee

    2011-01-01

    .... This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining...

  1. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  2. Rat indwelling urinary catheter model of Candida albicans biofilm infection.

    Science.gov (United States)

    Nett, Jeniel E; Brooks, Erin G; Cabezas-Olcoz, Jonathan; Sanchez, Hiram; Zarnowski, Robert; Marchillo, Karen; Andes, David R

    2014-12-01

    Indwelling urinary catheters are commonly used in the management of hospitalized patients. Candida can adhere to the device surface and propagate as a biofilm. These Candida biofilm communities differ from free-floating Candida, exhibiting high tolerance to antifungal therapy. The significance of catheter-associated candiduria is often unclear, and treatment may be problematic considering the biofilm drug-resistant phenotype. Here we describe a rodent model for the study of urinary catheter-associated Candida albicans biofilm infection that mimics this common process in patients. In the setting of a functioning, indwelling urinary catheter in a rat, Candida proliferated as a biofilm on the device surface. Characteristic biofilm architecture was observed, including adherent, filamentous cells embedded in an extracellular matrix. Similar to what occurs in human patients, animals with this infection developed candiduria and pyuria. Infection progressed to cystitis, and a biofilmlike covering was observed over the bladder surface. Furthermore, large numbers of C. albicans cells were dispersed into the urine from either the catheter or bladder wall biofilm over the infection period. We successfully utilized the model to test the efficacy of antifungals, analyze transcriptional patterns, and examine the phenotype of a genetic mutant. The model should be useful for future investigations involving the pathogenesis, diagnosis, therapy, prevention, and drug resistance of Candida biofilms in the urinary tract. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  3. Vascular calcification and subendocardial ischemia in hemodialysis patients: a new morpho-functional score to assess cardiovascular risk: the Solofra score.

    Science.gov (United States)

    Sirico, Maria L; Di Micco, Lucia; De Blasio, Antonella; Di Iorio, Biagio

    2014-01-01

    ESRD (end-stage renal disease) patients have a high cardiovascular mortality risk. A morphofunctional approach of vascular calcifications and myocardial perfusion is needed for the management of ESRD patients. We used SEVR (sub-endocardial viability ratio) and Kauppila score from the dialysis population of the Independent study to create a new morpho-functional score to assess cardiovascular risk in this population (the Solofra score). 184 patients were followed-up for 36 months. A side lumbar X-ray was performed to assess vascular calcifications of lumbar aorta using the Kauppila score. Central aortic pressure and pulse velocity wave (PWV) were assessed at the carotid artery site. Myocardial perfusion was estimated with SEVR. Independent risk mortality factors were identified with univariate regression analysis (p<0.01); significance was defined as p<0.05. Kauppila score was 13±10(range 0-24); PWV was 9.5±4 m/sec; basal SEVR was 1.3±0.9. We observed an improvement of ROC curves for SEVR and Kauppila score together compared to the ones for SEVR or Kauppila score alone. A quantitative analysis of vascular calcifications should be associated to a qualitative evaluation of arterial damage to better estimate cardiovascular mortality risk of ESRD patients. Further studies are needed to verify our hypothesis.

  4. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review

    Directory of Open Access Journals (Sweden)

    Luís Henrique Bezerra Cavalcanti Sette

    2014-04-01

    Full Text Available We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”. A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis than in the patients with normal renal function; this reduction has a multifactorial origin.

  5. Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

    Science.gov (United States)

    Hecking, Manfred; Bieber, Brian A.; Ethier, Jean; Kautzky-Willer, Alexandra; Sunder-Plassmann, Gere; Säemann, Marcus D.; Ramirez, Sylvia P. B.; Gillespie, Brenda W.; Pisoni, Ronald L.; Robinson, Bruce M.; Port, Friedrich K.

    2014-01-01

    Background A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality. Methods and Findings We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US) participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively) and mortality (via Cox regression) by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall), with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups hemodialysis patients was close to one. Compared to women, men were younger (mean = 61.9±standard deviation 14.6 versus 63.1±14.5 y), were less frequently obese, were more frequently married and recipients of a kidney transplant, more frequently had coronary artery disease, and were less frequently depressed. Interaction analyses showed that the mortality risk associated with several comorbidities and hemodialysis catheter use was lower for men (hazard ratio [HR] = 1.11) than women (HR = 1.33, interaction pdialysis or dying prior to a planned start of dialysis. Conclusions Women's survival advantage was markedly diminished in

  6. Telematics Service for Home and Satellite Hemodialysis.

    Science.gov (United States)

    Agroyannis, Basil; Fourtounas, Costas; Romagnoli, Gianfranco; Skiadas, Marios; Tsavdaris, Charalambos; Chassomeris, Costas; Tzanatos, Helen; Kopelias, Ioannis; Lymberopoulos, Dimitrios; Psarras, John

    1999-01-01

    Home hemodialysis (HD) for the treatment of end-stage renal disease was first implemented about 30 years ago. In this paper the application of telematics monitoring services for supporting patients who need home HD or satellite HD is described. Two modified HD machines were located in two renal units, and a central control station (CCS, UNIX workstation with multimedia PC terminal) was located in another room of the hospital. Bidirectional communication between the modified HD machines and the CCS was managed using ISDN (Integrated Services Digital Network) links. Nine patients had 150 HD sessions performed using these HD machines over a period of 5 months. This system, called the HOMER-D system, provided on-line, remote supervision of the HD machine-related functions and the clinical condition of the patients through measurement of blood pressure, pulse rate, PO2 (pulse oxymetry), and ECG from the CCS. Any disturbances in the functioning of the HD machines were both visible and audible in the CCS, and the observer could give teleconsultation to the renal unit staff. No major dialysis-associated complications were observed; all data and alarms were transmitted correctly; and patients received adequate HD treatment.

  7. Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis.

    Science.gov (United States)

    Jiménez-Almonacid, Pedro; Gruss, Enrique; Jiménez-Toscano, Marta; Lasala, Manuel; Rueda, José A; Vega, Laura; Rodríguez, Gil; de La Cruz, Raúl; Pardo, Mar; Fernández, Beatriz; López, Paula; Martín-Cavana, Jaime; Quintáns, Antonio

    2013-01-01

    Top analize the clinic results of the implantation of a multidisciplinary protocol to maintain permeability of the arteriovenous hemodialysis grafts (AVG). Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. Ninety six dysfunction AVG were collected for study. All of them were 6x40 mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience.

  8. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs

  9. Cytometric Catheter for Neurosurgical Applications

    Energy Technology Data Exchange (ETDEWEB)

    Evans III, Boyd Mccutchen [ORNL; Allison, Stephen W [ORNL; Fillmore, Helen [ORNL; Broaddus, William C [ORNL; Dyer, Rachel L [ORNL; Gillies, George [ORNL

    2010-01-01

    Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

  10. Higher Serum Levels of Free ĸ plus λ Immunoglobulin Light Chains Ameliorate Survival of Hemodialysis Patients

    DEFF Research Database (Denmark)

    Thilo, Florian; Caspari, Christina; Scholze, Alexandra

    2011-01-01

    Background/Aims: Impaired immune function is common in patients with chronic renal failure. Now, we determined whether serum levels of free immunoglobulin light chains predict mortality in patients with chronic kidney disease stage 5 on hemodialysis. Methods: We performed a prospective cohort study...... of 160 hemodialysis patients with a median follow-up of 15 months (interquartile range, 3-44 months). Serum levels of free κ and λ immunoglobulin light chains were measured at the start of the study. The primary end point was mortality from any cause. Results: In survivors, median serum levels of free κ....../l (χ(2) = 5.91; p = 0.015 by log-rank, Mantel-Cox, test). We performed univariate and multivariate regression analysis showing that older age and lower serum levels of free κ plus λ immunoglobulin light chains predicted mortality in hemodialysis patients. Conclusion: Higher serum levels of free κ plus...

  11. Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, Jean-Pierre; Fernandez, Pedro; Karila-Cohen, Pascale; Chillon, Sylvie; Schouman-Claeys, Elisabeth [Department of Radiology, Hopital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18 (France); Delmas, Vincent [Department of Urology, Hopital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18 (France); Dupuy, Emmanuel; Mignon, Francoise [Department of Nephrology, Hopital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18 (France)

    2003-02-01

    Preoperative imaging is indicated to discriminate patent, adequate superficial veins of the upper limbs undetectable by clinical inspection that could be anastomosed for the creation of a durable and functional hemodialysis fistula. The aim of this pictorial review is to provide a venous anatomic map of the upper limbs using MR venography (MRV) which could help surgeons before creation of hemodialysis access fistulas (AVF). At the level of the forearm, the antebrachial cephalic vein is the most commonly identified as patent. At the level of the elbow and distal arm, the cephalic vein is patent in 80% of normal subjects, and less often patent (23-26%) than basilic vein (33-38%) in patients. Overall, reading transaxial MR views can help for assessing upper limb vein anatomy before creation of a hemodialysis access fistula. (orig.)

  12. HEMODIALYSIS THERAPY SUSTAINED LOW EFFICIENCY DAILY DIALISIS FOR CHRONIC KIDNEY DESEASE PATIENT IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Gede Andry Nicolas

    2013-04-01

    Full Text Available Kidney failure is a clinical condition characterized by an irreversible decline in kidney function, to a degree that requires the permanent renal replacement therapy, in the form of dialysis or kidney transplantation. Dialysis consists of two major categories such as dialysis / hemodialysis intermittent and continuous dialysis / continuous renal replacement therapy (CRRT. SLEDD is the latest technique of renal replacement therapy that uses conventional hemodialysis equipment, but the therapeutic results like continuous dialysis therapy / CRRT were appropriate used in patien with critical ill.

  13. Influence of Frequent Nocturnal Home Hemodialysis on Food Preference

    NARCIS (Netherlands)

    Ipema, Karin; Franssen, Casper; van der Schans, Cees; Smit, Lianne; Noordman, Sabine; Haisma, Hinke

    Objective: Dialysis patients frequently report a change of taste that is reversible after renal transplantation, suggesting that uremic toxins may negatively influence taste. Currently, frequent nocturnal home hemodialysis (NHHD) is the most effective method of hemodialysis, and is associated with

  14. Factors associated with subendocardial ischemia risk in patients on hemodialysis

    National Research Council Canada - National Science Library

    Silva, Bruno Caldin da; Sanjuan, Adriano; Costa-Hong, Valéria; Reis, Luciene dos; Graciolli, Fabiana; Consolim-Colombo, Fernanda; Bortolotto, Luiz Aparecido; Moyses, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    ..., such vascular evaluation in patients on hemodialysis has not been extensively studied. Methods: In this cross-sectional study, hemodialysis patients were submitted to flow-mediated dilation, subendocardial viability ratio...

  15. Serum Soluble (ProRenin Receptor Levels in Maintenance Hemodialysis Patients.

    Directory of Open Access Journals (Sweden)

    Yoshifumi Amari

    Full Text Available The (prorenin receptor [(PRR] is cleaved by furin to generate soluble (PRR [s(PRR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis patients have advanced atherosclerosis. The aim of this study was to investigate the relationships between serum s(PRR levels and background factors, including indices of atherosclerosis, in hemodialysis patients. Serum s(PRR levels were measured in hemodialysis patients and clearance of s(PRR through the membrane of the dialyzer was examined. Furthermore, relationships between serum s(PRR levels and background factors were assessed. Serum s(PRR levels were significantly higher in hemodialysis patients (30.4 ± 6.1 ng/ml, n = 258 than those in subjects with normal renal function (21.4 ± 6.2 ng/ml, n = 39, P < 0.0001. Clearance of s(PRR and creatinine were 56.9 ± 33.5 and 147.6 ± 9.50 ml/min, respectively. Serum s(PRR levels were significantly higher in those with ankle-brachial index (ABI of < 0.9, an indicator of severe atherosclerosis, than those with ABI of ≥ 0.9 (32.2 ± 5.9 and 30.1 ± 6.2 ng/ml, respectively, P < 0.05. An association between low ABI and high serum s(PRR levels was observed even after correction for age, history of smoking, HbA1c, and LDL-C. Serum s(PRR levels were significantly higher in hemodialysis patients when compared with subjects with normal renal function, although s(PRR is dialyzed to some extent, but to a lesser extent than creatinine. High serum s(PRR levels may be associated with atherosclerosis independent of other risk factors, suggesting that serum s(PRR could be used as a marker for atherosclerotic conditions in hemodialysis patients.

  16. Vascular Access Outcomes Reported in Maintenance Hemodialysis Trials: A Systematic Review.

    Science.gov (United States)

    Viecelli, Andrea K; O'Lone, Emma; Sautenet, Benedicte; Craig, Jonathan C; Tong, Allison; Chemla, Eric; Hooi, Lai-Seong; Lee, Timmy; Lok, Charmaine; Polkinghorne, Kevan R; Quinn, Robert R; Vachharajani, Tushar; Vanholder, Raymond; Zuo, Li; Irish, Ashley B; Mori, Trevor A; Pascoe, Elaine M; Johnson, David W; Hawley, Carmel M

    2018-03-01

    Many randomized controlled trials have been performed with the goal of improving outcomes related to hemodialysis vascular access. If the reported outcomes are relevant and measured consistently to allow comparison of interventions across trials, such trials can inform decision making. This study aimed to assess the scope and consistency of vascular access outcomes reported in contemporary hemodialysis trials. Systematic review. Adults requiring maintenance hemodialysis. All randomized controlled trials and trial protocols reporting vascular access outcomes identified from ClinicalTrials.gov, Embase, MEDLINE, and the Cochrane Kidney and Transplant Specialized Register from January 2011 to June 2016. Any hemodialysis-related intervention. The frequency and characteristics of vascular access outcome measures were analyzed and classified. From 168 relevant trials, 1,426 access-related outcome measures were extracted and classified into 23 different outcomes. The 3 most common outcomes were function (136 [81%] trials), infection (63 [38%]), and maturation (31 [18%]). Function was measured in 489 different ways, but most frequently reported as "mean access blood flow (mL/min)" (37 [27%] trials) and "number of thromboses" (30 [22%]). Infection was assessed in 136 different ways, with "number of access-related infections" being the most common measure. Maturation was assessed in 44 different ways at 15 different time points and most commonly characterized by vein diameter and blood flow. Patient-reported outcomes, including pain (19 [11%]) and quality of life (5 [3%]), were reported infrequently. Only a minority of trials used previously standardized outcome definitions. Restricted sampling frame for feasibility and focus on contemporary trials. The reporting of access outcomes in hemodialysis trials is very heterogeneous, with limited patient-reported outcomes and infrequent use of standardized outcome measures. Efforts to standardize outcome reporting for vascular

  17. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  18. Copeptin in Hemodialysis Patients with Left Ventricular Dysfunction

    OpenAIRE

    Kim, Jae Seok; Yang, Jae Won; Chai, Moon Hee; Lee, Jun Young; Park, Hyeoncheol; Kim, Youngsub; Choi, Seung Ok; Han, Byoung Geun

    2015-01-01

    Purpose Copeptin has been considered as a useful marker for diagnosis and prediction of prognosis in heart diseases. However, copeptin has not been investigated sufficiently in hemodialysis patients. This study aimed to investigate the general features of copeptin in hemodialysis and to examine the usefulness of copeptin in hemodialysis patients with left ventricular dysfunction (LV dysfunction). Materials and Methods This study included 41 patients on regular hemodialysis. Routine laboratory...

  19. Catheter design for effective manual bladder irrigation.

    Science.gov (United States)

    Mesfin, Samuel; Sarkissian, Carl; Malaeb, Bahaa; Monga, Manoj

    2011-12-01

    We compared the efficiency of clearance of a simulated clot from a bladder model using a 6-hole irrigation catheter, a traditional Malecot catheter and a modified Malecot catheter with additional side holes. Latex balloons 12 inches in diameter served as the bladder model. They were filled with 300 cc Jell-O® gelatin, which had been partially solidified for 8 hours at 36F. Five manual irrigation/aspiration cycles with a 60 cc catheter tip syringe were performed to remove simulated clot from the bladder models and the amount of clot removed was measured. Five bladder models were used to test the efficiency of clot removal for each 22Fr catheter design, including a standard 22Fr Model 361222 Malecot latex 4-wing catheter (Rusch, High Wycombe, United Kingdom) and a 22Fr Bardex® Model 606118-22 latex 6-hole catheter. Two modified versions of the Malecot catheter design involving 2 and 4 additional holes were also tested to determine the effect of a hybrid 6-hole/Malecot design. The 6-hole catheter was more efficient for clot evacuation than the Malecot catheter (p = 0.014). The modified Malecot catheter with 4 additional holes was more efficient than the original Malecot catheter (p = 0.020). However, it was not significantly better than the 6-hole catheter. After 5 irrigation/aspiration cycles 77.0% of residual clot remained in the bladder with the Malecot catheter compared to 60.4% and 54.0% for the 6-hole and modified 4-hole Malecot catheters, respectively. The 6-hole catheter showed an advantage in clot removal over the Malecot catheter design. The enhanced ability of the 6-hole design to remove simulated clot may be attributable to the larger area covered by the holes at the catheter tip. Further investigation to determine the effect of spacing between the holes and the number of holes on the ability to break apart and remove clot is recommended for a more thorough understanding of differences among catheter models and methods of improvement. Copyright © 2011

  20. Treatment of hemodialysis vascular access arteriovenous graft failure by percutaneous intervention

    NARCIS (Netherlands)

    Planken, Robrecht Nils; van Kesteren, Floortje; Reekers, Jim A.

    2014-01-01

    A patent vascular access is the lifeline of end-stage renal disease patients depending on hemodialysis treatment. Once a functioning vascular access has been established, maintaining its patency is of utmost importance. During the last decades percutaneous techniques became increasingly important

  1. Mexican American Women's Adherence to Hemodialysis Treatment: A Social Constructivist Perspective

    Science.gov (United States)

    Tijerina, Mary S.

    2009-01-01

    Mexican Americans have as much as a six-times greater risk of end-stage renal disease (ESRD) than non-Hispanic white Americans, and women show a faster rate of decline in diabetic renal functioning. The leading treatment for ESRD is hemodialysis, an intensive, complex treatment regimen associated with high levels of patient nonadherence. Previous…

  2. Association between plasma endocannabinoids and appetite in hemodialysis patients: a pilot study

    Science.gov (United States)

    Weight loss is a well-recognized complication in subjects undergoing hemodialysis for impaired kidney function. This pilot study explored whether plasma levels of compounds known to mediate appetite, the endocannabinoids (EC) and EC-like compounds derived from polyunsaturated fatty acids (PUFA), ar...

  3. Building an antifouling zwitterionic coating on urinary catheters using an enzymatically triggered bottom-up approach.

    Science.gov (United States)

    Diaz Blanco, Carlos; Ortner, Andreas; Dimitrov, Radostin; Navarro, Antonio; Mendoza, Ernest; Tzanov, Tzanko

    2014-07-23

    Catheter associated urinary tract infections are common during hospitalization due to the formation of bacterial biofilms on the indwelling device. In this study, we report an innovative biotechnology-based approach for the covalent functionalization of silicone catheters with antifouling zwitterionic moieties to prevent biofilm formation. Our approach combines the potential bioactivity of a natural phenolics layer biocatalytically conjugated to sulfobetaine-acrylic residues in an enzymatically initiated surface radical polymerization with laccase. To ensure sufficient coating stability in urine, the silicone catheter is plasma-activated. In contrast to industrial chemical methods, the methacrylate-containing zwitterionic monomers are polymerized at pH 5 and 50 °C using as an initiator the phenoxy radicals solely generated by laccase on the phenolics-coated catheter surface. The coated catheters are characterized by X-ray photoelectron spectroscopy (XPS), Fourier transformed infrared (FTIR) analysis, atomic force microscopy (AFM), and colorimetrically. Contact angle and protein adsorption measurements, coupled with in vitro tests with the Gram-negative Pseudomonas aeruginosa and Gram-positive Staphylococcus aureus in static and dynamic conditions, mimicking the operational conditions to be faced by the catheters, demonstrate reduced biofilm formation by about 80% when compared to that of unmodified urinary catheters. The zwitterionic coating did not affect the viability of the human fibroblasts (BJ-5ta) over seven days, corresponding to the extended useful life of urinary catheters.

  4. Trace elements in renal disease and hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Miura, Yoshinori E-mail: yomiura@iwate-med.ac.jp; Nakai, Keiko; Suwabe, Akira; Sera, Koichiro

    2002-04-01

    A number of considerations suggest that trace element disturbances might occur in patients with renal disease and in hemodialysis (HD) patients. Using particle induced X-ray emission, we demonstrated the relations between serum concentration, urinary excretion of the trace elements and creatinine clearance (Ccr) in randomized 50 patients. To estimate the effects of HD, we also observed the changes of these elements in serum and dialysis fluids during HD. Urinary silicon excretion decreased, and serum silicon concentration increased as Ccr decreased, with significant correlation (r=0.702, p<0.001 and r=0.676, p<0.0001, respectively). We also observed the increase of serum silicon, and the decrease of silicon in dialysis fluids during HD. These results suggested that reduced renal function and also dialysis contributed to silicon accumulation. Although serum selenium decreased significantly according to Ccr decrease (r=0.452, p<0.01), we could detect no change in urinary selenium excretion and no transfer during HD. Serum bromine and urinary excretion of bromine did not correlate to Ccr. However we observed a bromine transfer from the serum to the dialysis fluid that contributed to the serum bromine decrease in HD patients.

  5. 21 CFR 876.5820 - Hemodialysis system and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hemodialysis system and accessories. 876.5820... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5820 Hemodialysis system and accessories. (a) Identification. A hemodialysis system and accessories is a device that is...

  6. 21 CFR 876.5665 - Water purification system for hemodialysis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Water purification system for hemodialysis. 876... SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5665 Water purification system for hemodialysis. (a) Identification. A water purification system for hemodialysis is a...

  7. The spectrum of hand dysfunction after hemodialysis fistula placement.

    Science.gov (United States)

    Rehfuss, Jonathan P; Berceli, Scott A; Barbey, Sarah M; He, Yong; Kubilis, Paul S; Beck, Adam W; Huber, Thomas S; Scali, Salvatore T

    2017-05-01

    Contemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery. Bilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at 6 weeks and 6 months following upper extremity AVF construction in 46 patients. Concurrently, biomechanical tests were administered to evaluate multiple limb functional domains including grip strength, dexterity, sensation and perception of hand function. Mean age was 59±14 years (75% male) and 48% were on hemodialysis at the time of access placement. 69% had a brachial-based AVF, and the remainder had radial-based accesses. Six weeks following AVF placement, a significant decrease in access side digital pressures was observed, with only partial recovery at 6 months (PGrip strength was significantly worse in the access side limb (P=0.0003), and Disability of Arm, Shoulder and Hand Questionnaire (DASH) score substantially worsened postoperatively (P=0.06). Digital sensation and limb dexterity did not differ between limb sides (P>0.1) or change significantly over time (P>0.1). Principal component analyses demonstrated that nerve conduction parameters tended to track the biomechanical parameters, yet both were relatively independent of the hemodynamic parameters. Our findings suggest that ischemia alone does not completely explain access-related hand dysfunction and that future study is needed to elucidate alternative mechanisms.

  8. Acute hemodialysis effects on doppler echocardiographic indices

    Directory of Open Access Journals (Sweden)

    Leila Abid

    2014-01-01

    Full Text Available Conventional echocardiographic (ECHO parameters of systolic and diastolic func-tion of the left ventricular (LV have been shown to be load dependent. However, the impact of pre-load reduction on tissue Doppler (TD parameters of LV function is incompletely understood. To evaluate the effect of a single hemodialysis (HD session on LV systolic and diastolic function using pulsed Doppler echocardiography and pulsed tissue Doppler imaging (TDI, we studied 81chronic HD patients (40 males; mean age 52.4 ± 16.4 years with these tools. ECHO parameters were obtained 30 min before and 30 min after HD. Fluid volume removed by HD was 1640 ± 730 cm [3] . HD led to reduction in LV end-diastolic volume (P <0.001, end-systolic volume (P <0.001, left atrium area (P <0.001, peak early (E-wave trans-mitral flow velocity (P <0.001, the ratio of early to late Doppler velocities of diastolic mitral inflow (P <0.001 and aortic time velocity integral (P <0.001. No significant change in peak S velocity of pulmonary vein flow after HD was noted. Early and late diastolic (E′ TDI velocities and the ratio of early to late TDI diastolic velocities (E′/A′ on the lateral side of the mitral annulus decreased signi-ficantly after HD (P = 0.013; P = 0.007 and P = 0.008, respectively. Velocity of flow progres-sion (Vp during diastole was not affected by pre-load reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (P <0.001 and P <0.001, respectively after HD. We conclude that most of the Doppler-derived indices of diastolic function are pre-load-dependent and velocity of flow progression was minimally affected by pre-load reduction in HD patients.

  9. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters.

    Science.gov (United States)

    Nifong, Thomas P; McDevitt, Timothy J

    2011-07-01

    Catheter-related thrombosis is a common complication in all anatomic sites, especially when smaller veins of the upper extremity are considered. It is presumed that the presence of a catheter within the lumen of a vein will decrease flow and potentially create stasis, and clinical data suggest that the size of the catheter impacts thrombosis rates. We sought to determine, both mathematically and experimentally, the impact of catheters on fluid flow rates. We used fluid mechanics to calculate relative flow rates as a function of the ratio of the catheter to vein diameters. We also measured the flow rate of a blood analyte solution in an annular flow model using diameters that simulate the size of upper extremity veins and commonly used peripherally inserted central catheters (PICCs). We compared each of the derived relative flow rates to the experimentally determined ones for three cylinder sizes and found a correlation of r(2) = 0.90. We also confirmed that the decrease in fluid flow rate with each successive catheter size is statistically significant (P centrally located obstruction. Assuming that blood flow in veins behaves in a similar manner to our models, PICCs, in particular, may substantially decrease venous flow rates by as much as 93%.

  10. Photoacoustic active ultrasound element for catheter tracking

    Science.gov (United States)

    Guo, Xiaoyu; Tavakoli, Behnoosh; Kang, Hyun-Jae; Kang, Jin U.; Etienne-Cummings, Ralph; Boctor, Emad M.

    2014-03-01

    In recent years, various methods have been developed to improve ultrasound based interventional tool tracking. However, none of them has yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. Our previous work has demonstrated a new active ultrasound pattern injection system (AUSPIS), which integrates active ultrasound transducers with the interventional tool, actively monitors the beacon signals and transmits ultrasound pulses back to the US probe with the correct timing. Ex vivo and in vivo experiments have proved that AUSPIS greatly improved tool visualization, and provided tool-tip localization accuracy of less than 300 μm. In the previous work, the active elements were made of piezoelectric materials. However, in some applications the high driving voltage of the piezoelectric element raises safety concerns. In addition, the metallic electrical wires connecting the piezoelectric element may also cause artifacts in CT and MR imaging. This work explicitly focuses on an all-optical active ultrasound element approach to overcome these problems. In this approach, the active ultrasound element is composed of two optical fibers - one for transmission and one for reception. The transmission fiber delivers a laser beam from a pulsed laser diode and excites a photoacoustic target to generate ultrasound pulses. The reception fiber is a Fabry-Pérot hydrophone. We have made a prototype catheter and performed phantom experiments. Catheter tip localization, mid-plan detection and arbitrary pattern injection functions have been demonstrated using the all-optical AUSPIS.

  11. Reduced deep regional cerebral venous oxygen saturation in hemodialysis patients using quantitative susceptibility mapping.

    Science.gov (United States)

    Chai, Chao; Liu, Saifeng; Fan, Linlin; Liu, Lei; Li, Jinping; Zuo, Chao; Qian, Tianyi; Haacke, E Mark; Shen, Wen; Xia, Shuang

    2018-02-01

    Cerebral venous oxygen saturation (SvO2) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing. 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO2, clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P deep regional cerebral SvO2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P deep regional cerebral SvO2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.

  12. Quality of Sleep and its Relationship to Quality of Life in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Kobra Parvan

    2013-11-01

    Full Text Available Introduction: Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients’ quality of life (QOL. This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. Methods: By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI, and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF. Results: 83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function. Conclusion: The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients’ quality of sleep and quality of life, especially those with lower education level and income, and older people.

  13. [Tuberculosis among chronic hemodialysis patients in Togo: Report of 10 cases].

    Science.gov (United States)

    Tsevi, Mawufemo Yawovi; Sabi, Akomola Kossi; Lawson-Ananissoh, Laté Mawuli; Noto-Kadou-Kaza, Befa; Amekoudi, Eyram Yoan

    2017-02-01

    To determine the frequency of tuberculosis among hemodialysis patients in Togo, specify its different localizations and identify its diagnostic and therapeutic difficulties. This was a retrospective study over a period of 5 years (2010-2015). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Sylvanus-Olympio University Teaching Hospital in Lomé. The diagnosis of tuberculosis was selected on the basis of clinical and laboratory data. The specific treatment has involved the association of 4 antituberculosis, which was adapted to the renal function. Of 91 chronic hemodialysis patients treated in Hospital Sylvanus-Olympio hemodialysis center, 10 cases (10.9%) of tuberculosis were diagnosed. The mean age was 37.3±12.8 years, and the sex ratio was 1.5. The median time to onset of tuberculosis after initiation of hemodialysis was 16.8±9 months. Extrapulmonary sites are found in 100% of cases (5 had both peritoneal and pleural localization, only 5 had pleural localization). The tuberculin skin test was positive in 4 patients (40%). The search for Mycobacterium tuberculosis was unsuccessful in all types of samples. Tuberculosis treatment was generally tolerated. Two patients (20%) had died during treatment. Tuberculosis is relatively common in hemodialysis patients. Diagnosis is difficult and may be based on the therapeutic trial. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  14. Catheter-based anatomic and functional assessment of coronary arteries in anomalous aortic origin of a coronary artery, myocardial bridges and Kawasaki disease.

    Science.gov (United States)

    Qureshi, Athar M; Agrawal, Hitesh

    2017-09-01

    Most diagnostic testing in patients with anomalous aortic origins of coronary arteries, myocardial bridges, and coronary artery changes after Kawasaki disease are performed with the use of noninvasive techniques. In some cases, however, further diagnostic information is needed to guide the clinician in treating these patients. In such instances, cardiac catheterization with invasive anatomic and functional testing is an invaluable tool. Moreover, interventional treatment in the cardiac catheterization laboratory may be performed in a small subset of these patients. As the diagnosis of these conditions is now becoming more common, it is important for pediatric interventional cardiologists to be familiar with these techniques. In this article, the role of angiography, intravascular ultrasound, fractional flow reserve, and optical coherence tomography in these patients is reviewed. © 2017 Wiley Periodicals, Inc.

  15. Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

    Science.gov (United States)

    Haq, Naveed Ul; Abdelsalam, Mohamed Said; Althaf, Mohammed Mahdi; Khormi, Abdulrahman Ali; Al Harbi, Hassan; Alshamsan, Bader; Albaqumi, Mamdouh Nasser; Broering, Dieter Clemens; Alkorbi, Lutfi; Aleid, Hassan Ali

    2017-01-18

    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. All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

  16. Hearing loss in geriatric hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Caner Sahin

    2015-01-01

    Full Text Available Introduction: The aim of the study was to evaluate the hearing loss in geriatric hemodialysis patients. Materials and Methods: The study was performed on 16 geriatric hemodialysis patients (age minimum: 65, maximum: 86 years and 16 volunteers (age minimum: 65, maximum: 86 years as a control group. The patients′ pure tone audiometry values between 250 and 8000 Hz frequencies were analyzed. Results: In our study, statistical significance was found between hearing loss and serum urea levels (P = 0.001. Hearing loss values were not statistically significantly different between the study and control groups (P = 0.786. High frequency hearing thresholds were found to be significantly higher in the geriatric hemodialysis patients (P = 0.032. Normal hearing levels at all levels were found in 5 patients in the study group. Mild to moderate hearing loss was found in 11 patients. Conclusions: In our preliminary study, we found statistically significant differences between the increase in hearing thresholds and uremia. Statistically significant changes in hearing thresholds at high frequencies were found between the two groups. Long-term hemodialysis treatment of 10 years or more is a risk factor for hearing loss. Hemodialysis treatment is a risk factor for hearing loss in geriatric patients who are at a risk of presbyacusis.

  17. Epidemiology of hemodialysis patients in Aleppo city

    Directory of Open Access Journals (Sweden)

    Moukeh Ghamez

    2009-01-01

    Full Text Available To determine the characteristics of the hemodialysis (HD patients in Aleppo city, we surveyed the hospitals representing the main dialysis centers in the city including private and community facilities during 2006. Personal patients′ interviews and hospitals records were the source of data. The total number of patients in 2006 undergoing HD was 550 patients; 280 (50.9% were males, and the age ranged from 5-82 years with mean and median age 44.7 and 45 years, respectively. The incidence (IR and prevalence rate (PR for hemodialysis were 60 pmp and 226 pmp, respectively. The major primary renal diseases in the end-stage renal disease (ESRD patients included hypertension (HTN, glomerulonephritis (GN, and diabetes mellitus (DM, 21.1%, 20.5 %, and 19.45, respectively. The percent of Anti-HCV, HBV hepatitis and HBV vaccine were 54.4%, 7.8%, and 52.9%, respectively. This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population.

  18. Pulmonary Artery Catheter Placement Using Transesophageal Echocardiography.

    Science.gov (United States)

    Cronin, Brett; Robbins, Robin; Maus, Timothy

    2017-02-01

    To assess the feasibility of pulmonary artery catheter placement using transesophageal echocardiography inclusive of a description of the technique. A prospective, proof-of-concept study. Single university hospital. Twenty patients with chronic thromboembolic pulmonary hypertension scheduled for pulmonary thromboendarterectomy. Pulmonary artery catheters were placed in 20 patients solely by transesophageal echocardiographic guidance. Placement of the pulmonary artery catheter in the pulmonary artery with transesophageal echocardiography guidance in fewer than 10 minutes was considered successful placement. The time to placement was measured from advancement of the pulmonary artery catheter in the superior vena cava (20 cm) to a final location at the junction of the right pulmonary artery and main pulmonary artery. All 20 pulmonary artery catheters were placed successfully using transesophageal echocardiography guidance and the median time to placement was 43 seconds. In 9 of the 20 patients (45%), the catheter was placed successfully on the first attempt without any adjustments. However, in 9 others (45%), the catheter required manipulation under transesophageal echocardiography vision. In 3 patients (15%), the pulmonary artery catheter was observed to be coiled in the right atrium and in 1 instance (5%) manipulation of the catheter in the right ventricle was required to enter the outflow tract. Transesophageal echocardiography is a viable adjunctive method to conventional pressure waveform placement of pulmonary artery catheters in potentially difficult patients. Published by Elsevier Inc.

  19. Outcome of radiologically placed tunneled haemodialysis catheters.

    Science.gov (United States)

    Sayani, Raza; Anwar, Muhammad; Tanveer-ul-Haq; Al-Qamari, Nauman; Bilal, Muhammad Asif

    2013-12-01

    To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Case series. Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed. Radiological guided tunneled

  20. Changes in Plasma Copeptin Levels during Hemodialysis: Are the Physiological Stimuli Active in Hemodialysis Patients?

    Science.gov (United States)

    Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.

    2015-01-01

    Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP), are operational in hemodialysis patients. Methods One hundred and eight prevalent, stable hemodialysis patients on a thrice-weekly dialysis schedule were studied during hemodialysis with constant ultrafiltration rate and dialysate conductivity in this observational study. Plasma levels of copeptin, sodium, MAP, and blood volume were measured before, during and after hemodialysis. Multivariate analysis was used to determine the association between copeptin (dependent variable) and the physiological stimuli plasma sodium, MAP, excess weight as well as NT-pro-BNP immediately prior to dialysis and between copeptin and changes of plasma sodium, MAP and blood volume with correction for age, sex and diabetes during dialysis treatment. Results Patients were 63±15.6 years old and 65% were male. Median dialysis vintage was 1.6 years (IQR 0.7–4.0). Twenty-three percent of the patients had diabetes and 82% had hypertension. Median predialysis copeptin levels were 141.5 pmol/L (IQR 91.0–244.8 pmol/L). Neither predialysis plasma sodium levels, nor NT-proBNP levels, nor MAP were associated with predialysis copeptin levels. During hemodialysis, copeptin levels rose significantly (pcopeptin levels during dialysis, whereas there was no significant association between the change in plasma sodium levels and the change in copeptin levels. Conclusions Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood volume, rather than osmotic stimuli, are associated with change in copeptin levels during hemodialysis. PMID

  1. Untangling of knotted urethral catheters

    Energy Technology Data Exchange (ETDEWEB)

    Sambrook, Andrew J. [Aberdeen Royal Infirmary, Department of Radiology, Aberdeen (United Kingdom); Todd, Alistair [Raigmore Hospital, Inverness (United Kingdom)

    2007-04-15

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation. (orig.)

  2. Habitual coffee consumption enhances attention and vigilance in hemodialysis patients.

    Science.gov (United States)

    Nikić, Petar M; Andrić, Branislav R; Stojimirović, Biljana B; Trbojevic-Stanković, Jasna; Bukumirić, Zoran

    2014-01-01

    Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

  3. Habitual Coffee Consumption Enhances Attention and Vigilance in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Petar M. Nikić

    2014-01-01

    Full Text Available Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants’ response to a dietary questionnaire. Results. Sixty-seven subjects (78% consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%. Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P=0.024. Conclusions. Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

  4. A Modified Open Surgery Technique for Peritoneal Dialysis Catheter Placement Decreases Catheter Malfunction

    Science.gov (United States)

    Jiang, Chunming; Xu, Linfeng; Chen, Yun; Yan, Xiang; Sun, Cheng; Zhang, Miao

    2014-01-01

    ♦ Background: This retrospective study was conducted to evaluate the effect of a new, modified open surgery technique on catheter-related malfunction. ♦ Methods: During the period from January 1997 to June 2009, 216 patients received initial peritoneal catheters. For the present study, patients were divided into four groups according to the catheter types and the surgery techniques: TO-S: traditional open surgery, straight Tenckhoff catheter TO-C: traditional open surgery, coiled Tenckhoff catheter TO-SN: traditional open surgery, swan-neck catheter MO-S: modified open surgery, straight Tenckhoff catheter The modified surgery was characterized by a low incision site, a short intra-abdominal catheter segment and an additional upward straight subcutaneous tunnel. All patients were followed up for 2 years or until death. Survival rates, complications caused by catheter placement, and the probability of malfunction-free catheter survival were compared between the groups. ♦ Results: Catheter malfunction was the most frequent mechanical complication, found in 31 patients (14.4%), who experienced 38 malfunctions. Only 2 episodes of catheter malfunction were found in the MO-S group, representing a rate significantly less than those in the TO-S and TO-C groups (both p catheter survival showed a significantly different malfunction-free probability for the various groups (p = 0.009). After 2 years of follow-up, 136 patients (63.0%) survived with their initial PD catheter. The initial catheter survival rate was 76.8% in the MO-S group. Kaplan-Meier curves for initial catheter survival showed that the highest survival rate was found in the MO-S group (p = 0.001). ♦ Conclusions: The modified open surgery technique is a reliable method for catheter placement. PMID:24991051

  5. Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop on Establishing a Core Outcome Measure for Hemodialysis Vascular Access.

    Science.gov (United States)

    Viecelli, Andrea K; Tong, Allison; O'Lone, Emma; Ju, Angela; Hanson, Camilla S; Sautenet, Benedicte; Craig, Jonathan C; Manns, Braden; Howell, Martin; Chemla, Eric; Hooi, Lai-Seong; Johnson, David W; Lee, Timmy; Lok, Charmaine E; Polkinghorne, Kevan R; Quinn, Robert R; Vachharajani, Tushar; Vanholder, Raymond; Zuo, Li; Hawley, Carmel M

    2018-02-22

    Vascular access outcomes in hemodialysis are critically important for patients and clinicians, but frequently are neither patient relevant nor measured consistently in randomized trials. A Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop was convened to discuss the development of a core outcome measure for vascular access. 13 patients/caregivers and 46 professionals (clinicians, policy makers, industry representatives, and researchers) attended. Participants advocated for vascular access function to be a core outcome based on the broad applicability of function regardless of access type, involvement of a multidisciplinary team in achieving a functioning access, and the impact of access function on quality of life, survival, and other access-related outcomes. A core outcome measure for vascular access required demonstrable feasibility for implementation across different clinical and trial settings. Participants advocated for a practical and flexible outcome measure with a simple actionable definition. Integrating patients' values and preferences was warranted to enhance the relevance of the measure. Proposed outcome measures for function included "uninterrupted use of the access without the need for interventions" and "ability to receive prescribed dialysis," but not "access blood flow," which was deemed too expensive and unreliable. These recommendations will inform the definition and implementation of a core outcome measure for vascular access function in hemodialysis trials. Copyright © 2018 National Kidney Foundation, Inc. All rights reserved.

  6. Massive hemorrhage due to hemodialysis-associated thrombocytopenia.

    Science.gov (United States)

    Vicks, S L; Gross, M L; Schmitt, G W

    1983-01-01

    Marked declines in platelet numbers were noted in association with hemodialysis. This resulted in gastrointestinal bleeding and the need for packed RBC and platelet transfusions. This hemodialysis-associated thrombocytopenia was ameliorated by changing the dialyzer in use. The gastrointestinal bleeding stopped and the need for platelet transfusions was obviated. The degree of platelet loss during hemodialysis is probably affected by the composition of the dialyzer membrane used as well as other factors. Hemodialysis-associated thrombocytopenia may be a contributing factor in the increased bleeding tendency noted in hemodialysis patients.

  7. Significance of intravascular and intracardiac movement of the cardiac catheter in ventriculo-atrial shunts (review of 655 cases).

    Science.gov (United States)

    Ahyai, A

    1979-01-01

    Proper placement of ventriculo-atrial shunts can be complicated by three phenomena: 1. Movement of the cardiac catheter intravascularly into the internal jugular vein as noted on chest X-ray. 2. Movement of the cardiac catheter during intraoperative X-ray leading to blurring and hence problems in accurate localization. 3. No sign on X-ray of the catheter tip or even of the catheter itself despite previous X-ray visualization and good function, a problem to be obviated by better radiopaque markings.

  8. Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS).

    Science.gov (United States)

    Hecking, Manfred; Bieber, Brian A; Ethier, Jean; Kautzky-Willer, Alexandra; Sunder-Plassmann, Gere; Säemann, Marcus D; Ramirez, Sylvia P B; Gillespie, Brenda W; Pisoni, Ronald L; Robinson, Bruce M; Port, Friedrich K

    2014-10-01

    A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality. We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US) participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively) and mortality (via Cox regression) by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall), with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups hemodialysis patients was close to one. Compared to women, men were younger (mean = 61.9 ± standard deviation 14.6 versus 63.1 ± 14.5 y), were less frequently obese, were more frequently married and recipients of a kidney transplant, more frequently had coronary artery disease, and were less frequently depressed. Interaction analyses showed that the mortality risk associated with several comorbidities and hemodialysis catheter use was lower for men (hazard ratio [HR] = 1.11) than women (HR = 1.33, interaction phemodialysis patients. The finding that fewer women than men were being treated with dialysis for end-stage renal disease merits detailed further study, as the large

  9. Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline.

    Science.gov (United States)

    Slinin, Yelena; Greer, Nancy; Ishani, Areef; MacDonald, Roderick; Olson, Carin; Rutks, Indulis; Wilt, Timothy J

    2015-11-01

    In 2006, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) published clinical practice guidelines for hemodialysis adequacy. Recent studies evaluating hemodialysis adequacy as determined by initiation timing, frequency, duration, and membrane type and prompted an update to the guideline. Systematic review and evidence synthesis. Patients with advanced chronic kidney disease receiving hemodialysis. We screened publications from 2000 to March 2014, systematic reviews, and references and consulted the NKF-KDOQI Hemodialysis Adequacy Work Group members. We included randomized or controlled clinical trials in patients undergoing long-term hemodialysis if they reported outcomes of interest. Early versus late dialysis therapy initiation; more frequent (>3 times a week) or longer duration (>4.5 hours) compared to conventional hemodialysis; low- versus high-flux dialyzer membranes. All-cause and cardiovascular mortality, myocardial infarction, stroke, hospitalizations, quality of life, depression or cognitive function scores, blood pressure, number of antihypertensive medications, left ventricular mass, interdialytic weight gain, and harms or complications related to vascular access or the process of dialysis. We included 32 articles reporting on 19 trials. Moderate-quality evidence indicated that earlier dialysis therapy initiation (at estimated creatinine clearance [eClcr] of 10-14mL/min) did not reduce mortality compared to later initiation (eClcr of 5-7mL/min). More than thrice-weekly hemodialysis and extended-length hemodialysis during a short follow-up did not improve clinical outcomes compared to conventional hemodialysis and resulted in a greater number of vascular access procedures (very low-quality evidence). Hemodialysis using high-flux membranes did not reduce all-cause mortality, but reduced cardiovascular mortality compared to hemodialysis using low-flux membranes (moderate-quality evidence). Few studies were adequately powered

  10. Usefulness of Interventional Treatment for Dysfunctional Hemodialysis Shunts of the Upper Arm by Means of the Retrograde Transradial Approach

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    Shin, Hwa Seon; Shin, Tae Beom; Na, Jae Beom; Jung, Seong Hoon; Kim, Hyun Jung; Lee, Jung Eun [Gyeongsang National University Hospital College of Medicine, Jinju (Korea, Republic of); Song, Yun Gyu [Masan Samsung Hospital, Sungkyunkwan University College of Medicine, Masan (Korea, Republic of); Jung, Gyoo Sik [Kosin University Hospital College of Medicine, Busan (Korea, Republic of)

    2010-11-15

    This study was designed to evaluate the technical feasibility and clinical outcome of endovascular intervention using the retrograde transradial approach to treat dysfunctional hemodialysis shunts of the upper arms. During the last 3 years, sixteen procedures were performed by the transradial approach in 13 patients with dysfunctional hemodialysis shunts of the upper arms. The radial artery was accessed with the use of 20-gauge needle and a 6-Fr sheath. Angiography was performed using a 5-Fr catheter placed in the brachial artery, and then the interventional procedure was performed. The technical and clinical success rates, complications and patency rates were evaluated. Fistulography and percutaneous transluminal angioplasty via the transradial approach were performed in 16 cases of the 13 patients. Fistulography demonstrated stenosis in 7 cases and occlusions in 9 cases. Lesion multiplicity was identified in 9 out of 16 cases. Balloon angioplasty was performed in all cases and a stent was placed to overcome restenosis or to treat venous rupture in two cases. The technical success rate of balloon angioplasty was 87.5% (14/16) and the technical success rate with including stent insertion was 100% (16/16). The clinical success rate was 93.8%. There was one procedural-related complication. The primary patency rates at 6 and 12 months were 84.6% and 74%, respectively. The transradial approach seems to be technically feasible and effective for the management of insufficient hemodialysis shunts of the upper arms

  11. Prevalence of fibromyalgia in hemodialysis patients.

    Science.gov (United States)

    Samimagham, Hamidreza; Haghighi, Anousheh; Tayebi, Mehdi; Jenabi, Arya; Arabi, Mohsen; Kianmehr, Nahid

    2014-05-01

    This study sought to determine the prevalence of fibromyalgia syndrome and to identify whether fibromyalgia was associated with various clinical symptoms and laboratory parameters in hemodialysis patients. One hundred and forty-eight hemodialysis patients were examined for fibromyalgia symptoms according to the American College of Rheumatology criteria. Demographic characteristics, as well as causes of kidney failure, dialysis duration, and symptoms related to fibromyalgia were investigated. Of 148 patients, 18 (12.2%) were diagnosed with fibromyalgia. Patients with fibromyalgia had significantly poorer sleeping satisfaction than the control group (P = .02).The Beck Depression Inventory score was higher in 77.8% of the fibromyalgia patients than that in the control group (P = .006), but there was no significant difference in the anxiety score between the two groups (P = .86).In conclusion, there was a higher prevalence of fibromyalgia in hemodialysis patients than previously reported. Sleep disturbances and depression levels correlated with fibromyalgia.

  12. [Knot in a thoracic epidural catheter].

    Science.gov (United States)

    Fischer, F; Helms, O; Hentz, J-G; Steib, A

    2011-02-01

    We report a case of impossible injection into a thoracic epidural catheter associated with a difficult withdrawal of this catheter after its introduction on the T3-T4 level. Thanks to a gentle and continuous traction, the catheter was finally successfully removed without being broken, but presented a simple knot at 13mm from its end. No neurological complication was observed later on. This complication happened during the introduction of the catheter at the thoracic level where anatomic conditions are less favorable for this kind of complication to happen than at the lumbar level. We have been probably confronted with a catheter taking an abnormal direction due to an anatomic structure. This case shows us that knots in an epidural catheter are also possible on the high thoracic level and that its ascent within the epidural space must happen without any resistance. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  13. Hemodialysis in the Poisoned Patient

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2017-09-01

    Full Text Available Audience: This classic team based learning (cTBL didactic is aimed for emergency medicine residents and fourth year medical students entering emergency medicine. Introduction: Over one million visits per year to United States (US emergency departments (ED are related to poisonings.1 Extracorporeal treatment (ECTR, specifically hemodialysis (HD, is one potential method to enhance elimination of certain drugs and their toxic metabolites.2-12 While HD may be life-saving in certain poisonings, it may have no effect on others and it carries associated risks and costs. It is essential that emergency physicians know the indications for HD in the poisoned patient. This cTBL reviews many poisonings which may be managed by HD. Objectives: By the end of this cTBL, the learner will: 1 recognize laboratory abnormalities related to toxic alcohol ingestion; 2 calculate an anion gap and osmolal gap; 3 know the characteristics of drugs that are good candidates for HD; 4 discuss the management of patients with toxic alcohol ingestions; 5 discuss the management of patients with salicylate overdose; 6 know the indications for HD in patients with overdoses of antiepileptic drugs; 7 discuss the management of patients with lithium toxicity. Method: This didactic session is a cTBL (classic team based learning.

  14. Vascular perfusion, body composition and muscle strength in chronic kidney disease patients on regular hemodialysis program

    OpenAIRE

    Bernardino, Bruna; Novo, André; Azevedo, Paulo; Mendes, Eugénia; Preto, Leonel

    2015-01-01

    Hemodialysis is a technique that effectively replaces some functions of the human kidney, allowing the survival of such patients, since loss of kidney function is incompatible with life. In most patients with chronic kidney disease, the level of renal function tends to gradually decrease over time. The most serious outcome of chronic kidney disease is renal failure. The vascular access is vital in patients with chronic renal failure undergoing dialysis and their dysfunction is a major cause o...

  15. Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study.

    Science.gov (United States)

    Yen, Yi-Hao; Chen, Jin-Bor; Cheng, Ben-Chung; Chen, Jung-Fu; Chang, Kuo-Chin; Tseng, Po-Lin; Wu, Cheng-Kun; Tsai, Ming-Chao; Lin, Ming-Tsung; Hu, Tsung-Hui

    2017-01-01

    Controlled attenuation parameter (CAP) is a non-invasive method for measuring hepatic steatosis (HS). Non-alcoholic fatty liver disease (NAFLD) is closely related to cardiovascular diseases (CVDs). CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis patients. We prospectively enrolled patients undergoing chronic hemodialysis, as well as patients with normal renal function who served as controls. The control group patients were referred by an endocrinologist to be tested for NAFLD; most of these patients had diabetes, hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known to induce HS, chronic viral hepatitis, or CAP failure. CAP ≥ 238 dB/m was used as a cutoff suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to make the diagnosis of HS. Three hundred and forty-three hemodialysis patients and 252 control group patients were enrolled. Among the hemodialysis patients, 192 (56.0%) had CAP- or ultrasound-identified HS compared with 91 (26.5%) who only had ultrasound-identified HS (Pcontrol group patients, 212 (84.1%) had CAP- or ultrasound-identified HS compared with 180 (71.4%) who only had ultrasound-identified HS (PCAP combined with ultrasound was more than 2 times the number made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.

  16. Automated Catheter Navigation With Electromagnetic Image Guidance.

    Science.gov (United States)

    Jaeger, Herman A; Nardelli, Pietro; O'Shea, Conor; Tugwell, Josef; Khan, Kashif A; Power, Timothy; O'Shea, Michael; Kennedy, Marcus P; Cantillon-Murphy, Padraig

    2017-08-01

    This paper describes a novel method of controlling an endoscopic catheter by using an automated catheter tensioning system with the objective of providing clinicians with improved manipulation capabilities within the patient. Catheters are used in many clinical procedures to provide access to the cardiopulmonary system. Control of such catheters is performed manually by the clinicians using a handle, typically actuating a single or opposing set of pull wires. Such catheters are generally actuated in a single plane, requiring the clinician to rotate the catheter handle to navigate the system. The automation system described here allows closed-loop control of a custom bronchial catheter in tandem with an electromagnetic tracking of the catheter tip and image guidance by using a 3D Slicer. An electromechanical drive train applies tension to four pull wires to steer the catheter tip, with the applied force constantly monitored through force sensing load cells. The applied tension is controlled through a PC connected joystick. An electromagnetic sensor embedded in the catheter tip enables constant real-time position tracking, whereas a working channel provides a route for endoscopic instruments. The system is demonstrated and tested in both a breathing lung model and a preclinical animal study. Navigation to predefined targets in the subject's airways by using the joystick while using virtual image guidance and electromagnetic tracking was demonstrated. Average targeting times were 29 and 10 s, respectively, for the breathing lung and live animal studies. This paper presents the first reported remote controlled bronchial working channel catheter utilizing electromagnetic tracking and has many implications for future development in endoscopic and catheter-based procedures.

  17. A broken catheter in the epidural space.

    Science.gov (United States)

    Anwari, Jamil S; Al-Wahbi, Yahya; Al-Nahdi, Saleh

    2014-04-01

    The Arrow FlexTip epidural catheter has reinforced coiled stainless steel wire, which facilitates its insertion and is less likely to puncture the blood vessels. However, as compared with non-reinforced, reinforced epidural catheters are more vulnerable to break. We report a case from Saudi Arabia on a retained fragment of a broken epidural catheter. Measures to prevent this mishap and its management are discussed.

  18. Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review.

    Science.gov (United States)

    Purnell, Tanjala S; Auguste, Priscilla; Crews, Deidra C; Lamprea-Montealegre, Julio; Olufade, Temitope; Greer, Raquel; Ephraim, Patti; Sheu, Johanna; Kostecki, Daniel; Powe, Neil R; Rabb, Hamid; Jaar, Bernard; Boulware, L Ebony

    2013-11-01

    A comprehensive assessment of the association of patients' renal replacement therapy (RRT) modality with their participation in life activities (physical function, travel, recreation, freedom, and work) is needed. Systematic review of peer-reviewed published studies. Adults undergoing RRT (hemodialysis, peritoneal dialysis, or transplantation). We searched PubMed, Cochrane Library, and EMBASE from January 1980 through April 2012 for English-language articles that compared participation in life activities among patients receiving: (1) hemodialysis compared with peritoneal dialysis, (2) hemodialysis compared with kidney transplantation, or (3) peritoneal dialysis compared with kidney transplantation. RRT modality. Reported rates of physical function, travel, recreation, freedom, and work-related activities by RRT modality. 46 studies (6 prospective cohort, 38 cross-sectional, and 2 pre-post transplantation) provided relevant comparisons of life participation activities among patients treated with hemodialysis, peritoneal dialysis, and kidney transplantation. Studies were conducted in 1985-2011 among diverse patient populations in 16 distinct locations. A majority of studies reported greater life participation rates for patients with kidney transplants compared with patients receiving either hemodialysis or peritoneal dialysis. In contrast, a majority of studies reported no differences in outcomes between patients receiving hemodialysis and patients receiving peritoneal dialysis. These results were consistent throughout the study period, across diverse populations, and among the subset of studies that performed appropriate adjustments for potential confounding factors. Many studies included in the review had significant design weaknesses. Evidence suggests that patients with kidney transplants may experience better rates of life participation compared with patients receiving dialysis, whereas patients receiving hemodialysis and patients receiving peritoneal dialysis

  19. Unplanned Start on Peritoneal Dialysis Right after PD Catheter Implantation for Older People with End-Stage Renal Disease.

    Science.gov (United States)

    Povlsen, Johan V; Sørensen, Anette Bagger; Ivarsen, Per

    2015-11-01

    Unplanned start on dialysis remains a major problem for the dialysis community worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far. Compared with planned start on PD after at least 2 weeks of break-in between PD catheter implantation and initiation of dialysis, unplanned start may be associated with a slight increased risk of mechanical complications but apparently no detrimental effect on mortality, peritonitis-free survival, or PD technique survival.In our opinion and experience, the risk of serious complications associated with the implantation and immediate use of a PD catheter is less than the risk of complications associated with unplanned start on HD with a temporary central venous catheter (CVC). Unplanned start on APD is a gentle, safe, and feasible alternative to unplanned start on HD with a temporary CVC that is also valid for the late-referred older patient with ESRD and urgent need for dialysis. Copyright © 2015 International Society for Peritoneal Dialysis.

  20. A Retrospective Quality Study of Hemodialysis Catheter-Related Bacteremia in a Danish Hospital

    DEFF Research Database (Denmark)

    Kaarup, Sophie; Olesen, Bente; Pourarsalan, Mahshid

    2016-01-01

    and surveillance is a critical aspect of infection control and prevention. Aim: To analyze incidence, causative species, and treatment of HD CRB in adult chronic HD patients at Nordsjaellands Hospital (NOH), Denmark. Methods: All episodes of bacteremia in the Department of Cardiology, Nephrology and Endocrinology...

  1. Inflammation, nutritional status, PUFA profile and outcome in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rašić-Milutinović Zorica

    2012-01-01

    Full Text Available Patients with end-stage renal disease (ESRD include a significant percentage of malnourished patients with other risk factors: dyslipoproteinemia, insulin resistance, increased oxidative stress and inflammation that together impair endothelial function. Abnormal polyunsaturated fatty acids (PUFA patterns are reported in patients with ESRD. The basic mechanisms of these disorders are connected with changes in cell functions at the membrane level. Vascular smooth muscle cell proliferation plays an important role in the pathogenesis of atherosclerosis. We have examined the association between atherosclerotic risk factors and nutritional status in hemodialysis (HD patients. Mortality was followed for up to 18 month. Forty-three HD patients were examined (20 males, 23 females, ages 55±12 years. Nutritional and inflammatory markers, including serum concentrations of C-reactive protein (CRP, tumor necrosis factor alpha (TNF-alpha, and interleukin 6 (IL-6, were measured. There was significant positive correlation between the plasma albumin level and CRP. Significant correlation was found between plasma the cholesterol level and some PUFA. Increasing inflammation and endothelial dysfunction predict the development of vascular disease. We report on the relationship between inflammatory markers and nutritional parameter, indices of atherosclerosis and other cardiovascular risk factors in patients on hemodialysis. [Acknowledgments. This research was supported by a project from the Serbian Ministry of Education and Science no.41030

  2. Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations.

    Science.gov (United States)

    Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D; Francis, Gary S; Tang, W H Wilson

    2017-04-01

    Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Should a Double-Lumen Catheter be withdrawn?

    Directory of Open Access Journals (Sweden)

    Samad Shams Vahdati

    2011-08-01

    Full Text Available Introduction: Haemodialysis needs a credible and recurrent access to the systemic circula-tion which can be accomplished by way of central vein catheterization. We report the case of bleeding after withdrawal of the double lumen catheter. Case Presentation: A 36-year-old woman who was a known case of end-stage renal disease referred to a dialysis center because of her arteriovenous fistula malfunction. A double-lumen catheter was inserted via the right internal jugular vein but failed to become functional so in the emergency department we decided to withdrawal catheter under cardiac monitoring and pulse oximetry but unfortunately A few minutes after the withdrawal of the double lumen Catheter the patient became agitated and confused. The resuscitation team after infusing IV fluid and blood decided to emergent thoracotomy. We control bleeding by direct pressure and repaired a rupture of the posterior aspect of the right internal jugular and right subclavian vein junction. Six hours later she became alert and one week after discharged, she was in well general condition.