Central venous catheter-related venous thrombosis in children with end-stage renal disease undergoing hemodialysis

Objectives: To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. Methods: The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Results: Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Conclusion: Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

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Rare cause of failure of central venous catheter insertion in a patient with end stage renal disease-septum in internal jugular vein

Saudi Journal of Anaesthesia ◽

10.4103/1658-354x.168837 ◽

2016 ◽

Vol 10 (2) ◽

pp. 241

Author(s):

Anshuman Singh ◽

Kamal Kajal ◽

Nitesh Agrawal ◽

Mandeep Dhankhar

Keyword(s):

Central Venous Catheter ◽

Renal Disease ◽

End Stage Renal Disease ◽

Jugular Vein ◽

Venous Catheter ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Cause Of Failure ◽

Stage Renal Disease ◽

End Stage

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Urgent-start peritoneal dialysis for end-stage renal disease patients: literature review and worldwide evidence-based practice

Renal Replacement Therapy ◽

10.1186/s41100-021-00384-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atthaphong Phongphithakchai ◽

Phongsak Dandecha ◽

Sukit Raksasuk ◽

Thatsaphan Srithongkul

Keyword(s):

Peritoneal Dialysis ◽

Central Venous Catheter ◽

Renal Disease ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Central Venous ◽

Dialysis Therapy ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage

AbstractThe prevalence of end-stage renal disease (ESRD) is on the rise worldwide. Meanwhile, the number of older people requiring dialysis therapy is increasing as a result of this population. We found that starting dialysis in an unplanned manner is a common occurrence, even for patients with nephrology follow-up. Most centers choose hemodialysis with a high rate of central venous catheter use at the time of initiation of dialysis. Current data has found that central venous catheter use is independently associated with increased mortality and high bacteremia rates. Peritoneal dialysis is one option to avoid bacteremia. The International Society for Peritoneal Dialysis guidelines suggests a break-in period of at least two weeks prior to an elective start of peritoneal dialysis, without mentioning urgent-start peritoneal dialysis. For unplanned ESRD patients, it is unrealistic to wait for two weeks before initiating peritoneal dialysis therapy. Urgent-start peritoneal dialysis has been suggested to be a practical approach of prompt initiation of peritoneal dialysis after catheter insertion, which may avoid an increased risk of central venous catheter-related complications, including bacteremia, central venous stenosis, and thrombosis associated with the temporary use of hemodialysis. Peritoneal dialysis is the alternative option, and many studies have presented an interest in urgent-start peritoneal dialysis. Some reports have compared urgent-start hemodialysis to peritoneal dialysis and found that urgent-start peritoneal dialysis is a safe and effective alternative to hemodialysis for an unplanned dialysis patient. This review aims to compare each literature report regarding techniques, prescriptions, outcomes, complications, and costs of urgent-start peritoneal dialysis.

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Comparison of the characteristics of patients with invasive infections and noninvasive infections caused by Trichosporon asahii

Medical Mycology ◽

10.1093/mmy/myaa076 ◽

2020 ◽

Author(s):

Jinyeong Kim ◽

Min Jae Kim ◽

Yong Pil Chong ◽

Sung-Han Kim ◽

Sang-Ho Choi ◽

...

Keyword(s):

Central Venous Catheter ◽

End Stage Renal Disease ◽

Hematologic Malignancy ◽

Venous Catheter ◽

Invasive Infection ◽

Central Venous ◽

Trichosporon Asahii ◽

Invasive Infections ◽

Stage Renal Disease ◽

End Stage

Abstract We performed retrospective study to identify the characteristics of invasive Trichosporon asahii infection. A total of 102 patients with T. asahii were identified including 18 (18%) with invasive infection. Invasive infection was associated with indwelling central venous catheter (94% vs 54%, P = .001), prior antifungal agent use (50% vs 18%, P = .01), hematologic malignancy (33% vs 7%, P = .006), and end-stage renal disease (28% vs 7%, P = .02). Patients with invasive infections had higher in-hospital mortality than patients with noninvasive infections (61% vs 27%, P = .006). Those with the above risk factors should be monitored for the development of invasive T. asahii infection. Lay summary Patients with indwelling central venous catheter, prior antifungal agent use, hematologic malignancy, and end-stage renal disease were associated with invasive Trichosporon asahii infection. Patients with invasive infections had higher in-hospital mortality than patients without invasive infection.

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Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa

The Journal of Vascular Access ◽

10.5301/jva.5000695 ◽

2017 ◽

Vol 18 (1_suppl) ◽

pp. S41-S46 ◽

Cited By ~ 2

Author(s):

Maurizio Gallieni ◽

Antonino Giordano ◽

Anna Ricchiuto ◽

Davide Gobatti ◽

Maurizio Cariati

Keyword(s):

Peritoneal Dialysis ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Infectious Complications ◽

Dialysis Access ◽

Central Venous ◽

Treatment Start ◽

Alternative Approach ◽

Stage Renal Disease ◽

End Stage

Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

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Effectiveness, safety and cost reduction of long-term tunneled central venous catheter insertion in outpatients performed by an interventional nephrologist

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0108 ◽

2020 ◽

Vol 42 (1) ◽

pp. 53-58

Author(s):

Artur Quintiliano ◽

Marcel Rodrigues Gurgel Praxedes

Keyword(s):

Central Venous Catheter ◽

Vascular Access ◽

Survival Rates ◽

Cost Savings ◽

Venous Catheter ◽

Central Venous ◽

Catheter Survival ◽

Stage Renal Disease ◽

End Stage

Abstract Introduction: Invasive procedures performed by trained nephrologists can reduce delays in making a definitive vascular access, complications, number of procedures on the same patient, and costs for the Public Health System. Objective: to demonstrate that a long-term tunneled central venous catheter (LTCVC) implanted by a nephrologist is safe, effective, and associated with excellent results. Methods: A retrospective study analyzed 149 consecutively performed temporary-to-long-term tunneled central venous catheter conversions in the operating room (OR) from a dialysis facility from March 2014 to September 2017. The data collected consisted of the total procedures performed, demographic characteristics of the study population, rates of success, aborted procedure, failure, complications, and catheter survival, and costs. Results: the main causes of end stage renal disease (ESRD) were systemic arterial hypertension and diabetes mellitus, 37.9% each. Patients had a high number of previous arteriovenous fistula (1.72 ± 0.84) and temporary catheter (2.87 ± 1.9) attempts until a definitive vascular access was achieved, while the preferred vascular site was right internal jugular vein (80%). Success, abortion, and failure rates were 93.3%, 2.7% and 4%, respectively, with only 5.36% of complications (minors). Overall LTCVC survival rates over 1, 3, 6, and 12 months were 93.38, 71.81, 54.36, and 30.2%, respectively, with a mean of 298 ± 280 days (median 198 days). The procedure cost was around 496 dollars. Catheter dysfunction was the main reason for catheter removal (34%). Conclusion: Our analysis shows that placement of LTCVC by a nephrologist in an OR of a dialysis center is effective, safe, and results in substantial cost savings.

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Multicenter Investigation of the Initial Hemodialysis Vascular Access and Its Related Factors in Hangzhou of China

BioMed Research International ◽

10.1155/2021/6628139 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Qisu Ying ◽

Yong Mao ◽

Xiangcheng Xie ◽

Ping Wu ◽

Jilin Ma ◽

...

Keyword(s):

Risk Factors ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Chronic Glomerulonephritis ◽

Central Venous ◽

Hemodialysis Vascular Access ◽

Stage Renal Disease ◽

End Stage

Objective. To investigate the initial hemodialysis vascular access in Hangzhou and provide evidence for improving the use of autologous arteriovenous fistula by identifying factors associated with the choice of initial vascular access. Methods. We retrospectively studied the initial hemodialysis vascular access of 257 patients in five hemodialysis units in Hangzhou of China during a 21-month period (January 2018 to September 2019). A logistic regression was used to identify the risk factors of failing to use an arteriovenous fistula at the initiation of hemodialysis. Results. (1) 257 participants with mean age 67.65 ± 13.43 years old were reviewed, including 165 males (64.2%) and 92 females (35.8%). The etiologies of end-stage renal disease included diabetic nephropathy (37.35%), chronic glomerulonephritis (31.13%), hypertensive nephropathy (14.01%), and other diseases (17.51%). Only 51 patients (19.84%) received arteriovenous fistula, whereas the remaining 206 patients (80.16%) initiated dialysis with a central venous catheter. (2) Logistic regression analysis revealed that the independent risk factors for central venous catheter at the initial hemodialysis were age >70 years old ( OR = 4.827 , p < 0.01 versus ≤70 years old), chronic glomerulonephritis as the primary etiology ( OR = 2.565 , p < 0.05 versus nonchronic glomerulonephritis) and eGFR <8.5 mL/min/1.73m2 ( OR = 2.283 , p < 0.05 versus eGFR ≥8.5 mL/min/1.73m2). Conclusion. The proportion of patients using arteriovenous fistula as the initial hemodialysis vascular access in Hangzhou was still low. The choice of vascular access for the first hemodialysis was related to age, eGFR, and the primary etiology of end-stage renal disease. Increasing the proportion of planned vascular access and arteriovenous fistula at the initiation of hemodialysis is still our current goal.

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Unplanned Hemodialysis Initiation and Low Geriatric Nutritional Risk Index Scores are Associated with End-Stage Renal Disease Outcomes

10.21203/rs.3.rs-1196211/v1 ◽

2022 ◽

Author(s):

Ryoichi Maenosono ◽

Daisuke Kobayashi ◽

Tomohisa Matsunaga ◽

Yusuke Yano ◽

Shunri Taniguchi ◽

...

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Risk Index ◽

Predictive Marker ◽

Venous Catheter ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index ◽

Stage Renal Disease ◽

End Stage

Abstract Background Patients with end-stage renal disease (ESRD) have low nutritional status, presenting a high mortality risk. The geriatric nutritional risk index (GNRI) is a predictive marker of malnutrition. However, it is unclear whether the association between unplanned hemodialysis (HD) and GNRI scores is related to mortality. Methods The 180 patients who underwent HD at our hospital were divided into two groups: unplanned initiation with a central venous catheter (CVC; n=73) or planned initiation with prepared vascular access (n=107). Results There were no significant differences in sex, age, malignant tumor, hypertension, and vascular disease, while there were significant differences in time from the first visit to HD initiation (0 vs. 7 times, p=0.012) and days between the first visit and HD (12 vs. 186 days, p<0.001). The CVC insertion group had significantly lower GNRI scores at initiation (85.5 vs. 98.8, p<0.001). The adjusted hazard ratios were 4.115 and 3.077 for the GNRI scores and frequency, respectively. Three-year survival was significantly lower in the CVC + low GNRI group (p<0.0001). GNRI after 1 month was significantly inferior in the CVC insertion group. Conclusions Inadequate general management due to late referral to the nephrology department is a risk factor for patients with ESRD.

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1152. Characteristics of Patients with Invasive Infections Caused by Trichosporon asahii

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1338 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S603-S603

Author(s):

Jinyeong Kim ◽

Min Jae Kim ◽

Yong Pil Chong ◽

Sung-Han Kim ◽

Sang-Ho Choi ◽

...

Keyword(s):

End Stage Renal Disease ◽

Hematologic Malignancy ◽

Venous Catheter ◽

Invasive Infection ◽

Central Venous ◽

Invasive Group ◽

Trichosporon Asahii ◽

Non Invasive ◽

Stage Renal Disease ◽

End Stage

Abstract Background Trichosporon asahii is main species for invasive infection by genus Trichosporon. There has been few data regarding the incidence, clinical characteristics, and treatment outcomes of T. asahii colonization and invasive infection. Methods We retrospectively reviewed the microbiological records of patients whose culture results were positive for T. asahii, from a tertiary hospital in South Korea between January 2009 and July 2018. Invasive disease was defined according to the consensus statement of the Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC-MSG). Results During the study period, a total of 259 clinical T. asahii isolates (137 urine, 55 respiratory specimen, 26 blood, 16 surgical site drainage, 9 tissue biopsy, 9 open discharge, 3 toe/nail, 2 pleural fluid and 2 stool) were collected from 102 patients. Of the 102 patients, 18 (18%) had invasive infection: fungemia (12 [67%]), complicated skin and soft tissue infection (3 [17%]), pneumonia with or without empyema (2 [11%]), and complicated intra-abdominal infection (1 [5%]). Invasive infection was associated with hematologic malignancy (33% vs. 7%, P=0.006), end stage renal disease requiring dialysis (28% vs. 7%, P=0.02), indwelling central venous catheter (94% vs. 54%, P =0.001), and prior antifungal agent use (50% vs. 18%, P=0.01). Invasive group had significantly higher in-hospital mortality than non-invasive group (61% vs. 27%, P = 0.006). Characteristics of 102 patients with invasive and non-invasive Trichosporon asahii disease Conclusion Invasive infection was associated with hematologic malignancy, end stage renal disease, indwelling of central venous catheter, and prior antifungal agent use, and high mortality up to 60%. Those with above risk factors should be monitored for development of invasive T. asahii infection. Disclosures All Authors: No reported disclosures

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