The Effect of Type and Vascular Access Quality on the Outcome of Chronic Hemodialysis Treatment

The long-term survival and quality of life of patients on hemodialysis is dependant on the adequacy of dialysis via an appropriately placed vascular access. The native arteriovenous fistula (AV fistula) at the wrist is generally accepted as the vascular access of choice in hemodialysis patients due to its low complication and high patency rates. It has been shown beyond doubt that an optimally functioning AV fistula is a good prognostic factor of patient morbidity and mortality in the dialysis phase. Recent clinical practice guidelines recommend the creation of a vascular access (native fistula or synthetic graft) before the start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. A multidisciplinary approach, including nephrologists, surgeons, interventional radiologists, and nurses should improve the hemodialysis outcome by promoting the use of native AV fistulae. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. This approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate, and a high maturation, even in risk groups such as elderly and diabetic patients. Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results also support clinical practice guidelines that recommend the preferential placement of a native fistula.

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P1296CARDIAC COMPLICATIONS OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH END-STAGE RENAL DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1296 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nessrine Breik ◽

Hela Jbeli ◽

Safa Fattoum ◽

Imen Ouertani ◽

Badreddine Ben kaab ◽

...

Keyword(s):

Vascular Access ◽

Interventricular Septum ◽

Left Ventricular ◽

Chronic Hemodialysis ◽

Cardiac Complications ◽

Arteriovenous Fistulas ◽

Coronary Syndrome ◽

Group 2 ◽

Stage Renal Disease ◽

Cardiac Status

Abstract Background and Aims Current literature suggests the arteriovenous fistula (AVF) to be the preferred type of vascular access for hemodialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. The aim of this study is to compare the clinical and echocardiographic evolution after creation of a proximal AVF and a radial AVF. Method We conducted a retrospective descriptive study including all chronic hemodialysis patients through AVF. Group 1 (G1) included patients with proximal AVF and group 2 (G2) patients with radial AVF. Results Twenty-four patients were collected in G1 and the average age was 55 years. G2 included 13 patients with a mean age of 44 years. Systolic blood pressure decreased after AVF creation in both groups (G1: 62.5%, G2: 45%, NS). A dyspnea was noted in 70% of cases of G1 and 38.4% of cases of G2 (NS). The interventricular septum was thickened in 20.8% of cases of G1 and 38.4% of G2 (NS). Left ventricular (LV) dilatation was observed in both groups with LV diastolic telegram diameter increase of 58% in G1 versus 10% in G2 (p = 0.04). A decrease in LV ejection fraction was found in 62.5% in G1 and 46.1% in G2 (p = 0.066). The major cardiac complications in G1 were acute coronary syndrome in 5 patients and atrial fibrillation in 4 cases after an average of 60 months and 35 months, respectively. No cardiac complications were noted in G2. Conclusion AVFs remain the preferred type of vascular access for chronic hemodialysis therapy because they are associated with better long-term patency and fewer complications compared with synthetic grafts. Its seat will depend on the vascular state and the cardiac status of the dialysis patient.

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Cefazolin serum concentrations with fixed intravenous dosing in patients on chronic hemodialysis treatment

Nephrology Dialysis Transplantation ◽

10.1093/ndt/14.8.2050 ◽

1999 ◽

Vol 14 (8) ◽

pp. 2050-2051 ◽

Cited By ~ 13

Author(s):

D. Kuypers ◽

J. Vanwalleghem ◽

B. Maes ◽

T. Messiaen ◽

Y. Vanrenterghem ◽

...

Keyword(s):

Chronic Hemodialysis ◽

Serum Concentrations ◽

Hemodialysis Treatment

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Placement, Performance and Complications of the Ash Split Cath™ Hemodialysis Catheter

The International Journal of Artificial Organs ◽

10.1177/039139880202501204 ◽

2002 ◽

Vol 25 (12) ◽

pp. 1137-1143 ◽

Cited By ~ 4

Author(s):

M. Gallieni ◽

P.A. Conz ◽

E. Rizzioli ◽

A. Butti ◽

D. Brancaccio

Keyword(s):

Vascular Access ◽

Good Alternative ◽

Chronic Hemodialysis ◽

Dialysis Session ◽

Dialysis Dose ◽

Hemodialysis Catheter ◽

Venous Fistula ◽

Tunneled Catheter ◽

Urea Reduction Ratio

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath™, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron® cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 ± 20 ml/min at 1 week after insertion, 306 ± 17 ml/min at 3 months, 299 ± 44 ml/min at 6 months, and 308 ± 16 ml/min at 12 months. With a mean dialysis session duration of 234 ± 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71%±8 or a mean urea kinetic modeling, or Kt/V, value of 1.51±0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.

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Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

The Journal of Vascular Access ◽

10.5301/jva.2008.4872 ◽

2003 ◽

Vol 4 (1) ◽

pp. 21-24 ◽

Cited By ~ 1

Author(s):

M. Onaran ◽

D. Erer ◽

I. Şen ◽

E.E. Elnur ◽

E. Iriz ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Brachial Artery ◽

Subcutaneous Tissue ◽

Vascular Grafts ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Basilic Vein ◽

Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

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Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh161228138d ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 316-319

Author(s):

Branislav Donfrid ◽

Olivera Lozance ◽

Zvezdan Stefanovic ◽

Aleksandar Jankovic ◽

Nada Dimkovic

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Duplex Sonography ◽

Distal Region ◽

Original Method ◽

Late Complications ◽

Primary Patency ◽

Chronic Hemodialysis ◽

Secondary Patency ◽

Basilic Vein

Introduction. The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline. The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion. AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

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Screening needs and expectations of patients with vascular access due to chronic hemodialysis

Journal of Health Sciences ◽

10.17532/jhsci.2016.402 ◽

2016 ◽

Vol 6 (3) ◽

pp. 184-187

Author(s):

Tanja Carli ◽

Tadeja Pintar ◽

Uroš Godnov

Keyword(s):

Vascular Access ◽

Retrospective Cohort ◽

Young Patients ◽

Life Quality ◽

Medical Personnel ◽

Chronic Hemodialysis ◽

Hemodynamic Stability ◽

Reconstructive Procedures ◽

Married Men ◽

Pseudo Aneurysm

There is a lack of data about daily difficulties and life quality, especially among young patients having arteriovenous fistula (AVF) affected by (pseudo)aneurysm. In this retrospective cohort study, 195 patients with AVF were followed up from May to June 2015. An unstandardized questionnaire was used for the evaluation of patients’ screening needs and expectations. Retired married men in their sixties, with completed secondary education, represented the majority of patients with AVF in this study. The patients had a positive attitude towards the disease and AVF, and they received the majority of information related to the care and treatment of AVF from the medical personnel and doctors in selected dialysis centers. Employed, well-educated single men, aged between 21 and 40 years, had the highest interest in having an aesthetic correction of AVF, especially due to the formation of (pseudo)aneurysm at the AVF site. Establishment of rules for reconstructive procedures of AVF, once circulatory and hemodynamic stability is achieved after renal transplantation, is suggested in addition to establishing criteria for determining vascular access affected by (pseudo)aneurysm.

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MO715PROFILE OF INFECTIVE ENDOCARDITIS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Samarra Badrouchi ◽

Hajji Mariem ◽

Samia Barbouch ◽

Fethi Ben Hmida ◽

Harzallah Amel ◽

...

Keyword(s):

Infective Endocarditis ◽

Vascular Access ◽

Rare Complication ◽

Hemodialysis Patients ◽

Infectious Complications ◽

Chronic Hemodialysis ◽

Therapeutic Modalities ◽

Duke Criteria ◽

Profile Characteristics ◽

Subclavian Catheter

Abstract Background and Aims Infectious complications are the second leading cause of death in hemodialysis patients. This population is particularly exposed to bacteremia, on the one hand, because of the vascular access necessary for hemodialysis, which is a gateway to the various micro-organisms, and on the other hand, factors of susceptibility to infections. Infective endocarditis (IE) is the cardiac endothelium infection associated with bacteremia. It is a rare complication but its mortality remains high especially in patients on chronic hemodialysis. The aim of this study was to determine the microbiological profile, clinical and-biological profile, characteristics in the ultrasound, therapeutic modalities, and prognosis of IE in hemodialysis. Method This is a retrospective descriptive study of including chronic hemodialysis patients, admitted in the Nephrology and Internal Medicine Department A of the Charles Nicolle Hospital in Tunis for an IE during the period from 1973 to 2018. We used the modified Duke criteria to confirm the diagnosis of IE. Results Nineteen patients were included, including 12 men and 7 women (gender ratio=1.7). The average age was 49.1 years [29-66 years]. Seven of them (37%) were known to have a valvular disease, two of them had a double mitro-aortic valve replacement. Six of them (32%) were diabetic and two patients (11%) were on immunosuppressive therapy. The vascular access initially used for HD were arteriovenous fistula in 9 cases (47%), internal jugular catheter in 3 cases (16%), subclavian catheter in 1 case (5%), Canaud catheter in 3 cases (16%), and 2 patients were dialyzed by femoral catheter (11%). Clinically, all patients had an altered general condition, fever was present in 14 cases (74%) and a heart murmur in 10 cases (53%). Blood cultures were positive in 14 cases (74%). The isolated germs were Staphylococcus Aureus in 8 cases, Staphylococcus epidermidis in 4 cases, Pseudomonas aerogenosa in 3 cases, Enterobacterium in 1 case, enterococcus faecalis in 1 case, and Klebsielle oxytoca in one patient. On cardiac ultrasound, mitral valve damage was found in 10 patients, aortic sigmoid in 4 patients and tricuspid valve in 3 patients. The treatment included appropriate antibiotic therapy in all cases and a valvuloplasty was indicated in 7 patients. Nine patients (47%) died during their hospitalization. Conclusion Hemodialysis patients are particularly exposed to IE. The most appropriate preventive method is the strict observance of asepsis when handling the vascular access first and the rapid eradication of all infectious outbreaks.

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