scholarly journals Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Yu Soma ◽  
Masaaki Murakami ◽  
Eiji Nakatani ◽  
Yoko Sato ◽  
Satoshi Tanaka ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brachial Artery ◽  
Severe Heart Failure ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Arteriovenous Access ◽  
One Year

AbstractSome hemodialysis patients are not suitable for creation of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, they can receive a tunneled cuffed central venous catheter (tcCVC), but this carries risks of infection and mortality. We aimed to evaluate the safety and effectiveness of brachial artery transposition (BAT) versus those of tcCVC. This retrospective study evaluated hemodialysis patients who underwent BAT or tcCVC placement because of severe heart failure, hand ischemia, central venous stenosis or occlusion, inadequate vessels for creating standard arteriovenous access, or limited life expectancy. The primary outcome was whole access circuit patency. Thirty-eight patients who underwent BAT and 25 who underwent tcCVC placement were included. One-year patency rates for the whole access circuit were 84.6% and 44.9% in the BAT and tcCVC groups, respectively. The BAT group was more likely to maintain patency (unadjusted hazard ratio: 0.17, 95% confidence interval: 0.05–0.60, p = 0.006). The two groups did not have significantly different overall survival (log-rank p = 0.146), although severe complications were less common in the BAT group (3% vs. 28%, p = 0.005). Relative to tcCVC placement, BAT is safe and effective with acceptable patency in hemodialysis patients not suitable for AVF or AVG creation.

Brachial Artery Transposition Versus Catheters as Tertiary Vascular Access for Maintenance Hemodialysis: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Soma Yu ◽  
Masaaki Murakami ◽  
Eiji Nakatani ◽  
Yoko Sato ◽  
Satoshi Tanaka ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brachial Artery ◽  
Severe Heart Failure ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Arteriovenous Access ◽  
One Year

Abstract Background: Some hemodialysis patients are not suitable for creation of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). They can receive a tunneled cuffed central venous catheter (tcCVC), but this carries risks of infection and mortality. We aimed to evaluate the safety and effectiveness of brachial artery transposition (BAT) versus those of tcCVC.Methods: This retrospective study evaluated hemodialysis patients who underwent BAT or tcCVC placement because of severe heart failure, hand ischemia, central venous stenosis or occlusion, inadequate vessels for creating standard arteriovenous access, or limited life expectancy. The primary outcome was whole access circuit patency.Results: Thirty-eight patients who underwent BAT and 25 who underwent tcCVC placement were included. One-year patency rates for the whole access circuit were 84.6% and 44.9% in the BAT and tcCVC groups, respectively. The BAT group was more likely to maintain patency (unadjusted hazard ratio: 0.17, 95% confidence interval: 0.05-0.60, p=0.006). The two groups did not have significantly different overall survival (log-rank p=0.146), although severe complications were less common in the BAT group (3% vs. 28%, p=0.005).Conclusions: Relative to tcCVC placement, BAT is safe and effective with acceptable patency in hemodialysis patients not suitable for AVF or AVG creation.

scholarly journals Risk Factors for Low Humoral Response to BNT-162b2 In Hemodialysis Patients

2021 ◽  
Author(s):  
Rui Duarte ◽  
Cátia Figueiredo ◽  
Ivan Luz ◽  
Francisco Ferrer ◽  
Hernâni Gonçalves ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Humoral Response ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Older Age ◽  
Maintenance Hemodialysis ◽  
List Type ◽  
Central Venous ◽  
Dialysis Vintage

AbstractIntroductionMaintenance Hemodialysis (HD) patients are at higher risk of both infection and mortality associated with the new coronavirus 2. Immunization through large-scale vaccination is the cornerstone of infection prevention in this population. This study aims to identify risk factors for low response to the BNT-162b2 (Pfizer BioNTech) vaccine in a HD cohort.Materials and MethodsObservational prospective study of a HD group followed in a Portuguese Public Founded Hemodialysis Center who received BNT-162b2 vaccination. Specific anti-Spike IgG was evaluated as arbitrary units per milliliter (AU/mL) on two separate occasions: 3 weeks after the first dose and 3 weeks after the second. IgG titers, Non-Responders (NR), and Weak-Responders (WR) after each dose were evaluated against risk factors that included demographic, clinical and analytical variables.ResultsHumoral response evaluated by IgG anti-Spike levels showed a strong correlation with Charlson comorbidity index (CCI) and intact parathormone (iPTH) after each inoculation (1st dose: ρ=−0.64/0.54; 2nd dose: ρ=−0.66/0.63, respectively; p<0.01 throughout). After completing both doses: 1) NR were associated with female sex (p<0.01), lower albumin and iPTH (p=0.01); 2) WR showed higher CCI, older age, lower iPTH and lower albumin (p=<0.01, p=0.03, p<0.01, p=0.05, respectively) and, consistently, associated with CCI over 8, age over 75, iPTH under 150 ng/L, female sex, dialysis vintage under 24 months and central venous catheter (CVC) over arteriovenous fistula (p=0.01, p=0.03, p<0.01, p=0.01, p=0.01, p<0.01, respectively). A binary regression model using CCI, sex (male) and CVC was statistically significant in prediction of WR after the 2nd dose with OR (95% CI): 1.81 (1.06-3.08); 0.05 (0.01-0.65); 13.55 (1.06-174.18), respectively (p=0.01).ConclusionOlder age, higher CCI, lower iPTH and albumin, CVC as vascular access and recent hemodialysis initiation (less than 2 years) associate with lower response to vaccination in our study. A higher comorbidity burden is suggested as a more significant surrogate marker for low immunogenicity rather than age alone. Identifying HD patients as a population at high-risk for low response to vaccination is essential for proper policy-making, facilitating the implementation of adequate and individualized contingency protocols.What is already known about this subjectMaintenance hemodialysis patients have lower humoral response to BNT-162b2 COVID-19 vaccine when compared to the general population.Maintenance dialysis patients are at high risk of exposure to coronavirus 2 in addition to a more severe disease course.What this study addsWe suggest Charlson commorbidity index, older age, intact parathormone, central venous catheter as vascular access and lower dialysis vintage as possible surrogate markers of immunogenicity in HD patients.There is a low humoral response after a single dose of the vaccine (50%) that can be increased after the second (86%).What impact this may have on practice or policyStrict Protocols for follow-up measures in HD patients, including closer humoral titers assessment, risk stratification, adequate isolation, and surveillance of symptoms might be necessary in order to improve this population survival/life expectancy.Screening HD patients, seroconversion rates may be improved by giving extra inoculations for patients at risk for low response.

Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

2019 ◽  
Vol 21 (3) ◽  
pp. 322-327
Author(s):  
Rita L McGill ◽  
Eduardo K Lacson
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Venous Catheter ◽  
The United States ◽  
First Year ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Access ◽  
One Year

Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable ‘maturing’ arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts. Methods: The United States Renal Data System records for all adult patients initiating haemodialysis with central venous catheters between July 2010 and December 2011. Patients were categorized by whether a maturing arteriovenous fistula or graft was present. Transition to working arteriovenous fistula or graft was determined from linked Medicare claims. Modality changes and survival were ascertained. A logistic model for one-year survival and a subdistribution hazards model for transition to working arteriovenous fistula or graft, accounting for the competing risk of death, were constructed. Results: Compared to central venous catheter-only, maturing arteriovenous fistula or graft was associated with access conversion (hazard ratio = 2.23 (2.17–2.30) and 3.25 (2.97–3.56), respectively, p < 0.001 for both). Median time to conversion, among those who transitioned, was 95 days (interquartile range = 56–139) for patients with a maturing arteriovenous graft and 135 days (98–198) with a maturing arteriovenous fistula, versus 193 days (138–256) with central venous catheter-only. Pre-dialysis nephrology care, male sex and non-Caucasian race were associated with access conversion. Patients without a maturing arteriovenous fistula or graft had decreased odds of one-year survival (odds ratio = 0.61 (0.58–0.66), p < 0.001), which attenuated with adjustment for access conversion (adjusted odds ratio = 1.06 (0.98–1.13), p = 0.2). Conclusion: Maturing arteriovenous fistulas or grafts were associated with enhanced first-year survival and increased opportunity for working arteriovenous fistulas or grafts, which may reflect pre-dialysis decision-making, quality of care and comorbid diseases. Central venous catheter exposure was substantial, even among patients with maturing access. Contributory factors prolonging conversion to arteriovenous access need to be identified and addressed.

scholarly journals Vascular access for hemodialysis: Current practice in Vietnam

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 20-23 ◽  
Author(s):  
Long Duc Dinh ◽  
Dung Huu Nguyen
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Central Venous Catheters ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Central Venous ◽  
Advanced Country

A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure, which directly affects the quality of life in hemodialysis patients. We use three main types of access: native arteriovenous fistula, arteriovenous graft, and central venous catheter. Arteriovenous fistula remains the first and best choice for chronic hemodialysis. It is the best access for longevity, the lowest related complications, and for this reason, arteriovenous fistula use is strongly recommended by guidelines from different countries, including Vietnam. In practice, well-functioning arteriovenous fistula creation is not always simple. In this case, arteriovenous fistula creation with vein transposition or translocation is certainly useful. When native vein options have been exhausted, prosthetic can be used as the second option of maintenance hemodialysis access alternatives. Central venous catheters are very common and have become an important adjunct in maintaining patients on hemodialysis. In Bach Mai hospital, we certainly create about 1000 new arteriovenous fistulas every year (among these, about 84.98% new hemodialysis patients start hemodialysis without permanent accesses and depend on temporary central venous catheters) and successfully matured arteriovenous fistula rate is 92.6%. Among hemodialysis population in Bach Mai, 2.29% have arteriovenous grafts and 2.81% of patients still depend on cuffed tunneled catheters. The preferable locations for catheter insertions are the internal jugular and femoral veins. Proper vascular access maintenance requires integration of different professionals to create a vascular access team. Percutaneous transluminal angioplasty is not available. In our circumstance, we have achieved some advantages for hemodialysis patients but still a big gap to an advanced country.

scholarly journals POS-542 The Epidemiology and outcome of COVID-19 among maintenance hemodialysis patients: a retrospective study from a dialysis network in India

2021 ◽  
Vol 6 (4) ◽  
pp. S236-S237
Author(s):  
S. Sankarasubbaiyan ◽  
G. Mallikarjun ◽  
H. Mohammed S ◽  
V. Sonawane ◽  
K. Kaparaboina K. K ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Maintenance Hemodialysis Patients

scholarly journals Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

2010 ◽  
Vol 18 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Cibele Grothe ◽  
Angélica Gonçalves da Silva Belasco ◽  
Ana Rita de Cássia Bittencourt ◽  
Lucila Amaral Carneiro Vianna ◽  
Ricardo de Castro Cintra Sesso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Severe Infection ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Double Lumen ◽  
One Year ◽  
Very High

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

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