scholarly journals Beraprost sodium versus clopidogrel for preventing vascular thromboembolic events of arteriovenous fistula in uraemic patients: a retrospective study with a mean 3-year follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 252-264
Author(s):  
Ziming Wan ◽  
Ying Zhu ◽  
Ruikun Yang ◽  
Yongjian Zhang ◽  
Chen Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Primary Endpoint ◽  
Peroral Administration ◽  
Thromboembolic Events ◽  
Fistula Surgery ◽  
Beraprost Sodium ◽  
Stage Renal Disease ◽  
End Stage ◽  
Delayed Time

Objective This study aimed to evaluate the efficacy of beraprost sodium (BPS) or clopidogrel (CL) using vascular thromboembolic events (VTEs) of arteriovenous fistula as a primary endpoint in patients with end-stage renal disease (ESRD) undergoing arteriovenous fistula surgery. Methods We performed a multicentre, retrospective cohort study from August 2012 to August 2016. We studied patients with ESRD who underwent arteriovenous fistula surgery and received peroral administration of 40 µg BPS, three times per day, for 1 month, or 75 mg CL (initial dose of 300 mg), one time per day, for 1 month. The time to first on-study VTE was the primary endpoint. Results The BPS-treated cohort had a significantly delayed time to first VTE compared with the CL-treated cohort (hazard ratio 0.33, 95% confidence interval 0.18–0.56). An increased incidence of VTEs was detected in the 1-month follow-up, with rates of 2.4% and 8.7% for BPS and CL, respectively. This difference persisted over time, with rates of 8.0% and 18.1% at the final follow-up, respectively. Conclusion CL-treated patients with ESRD have a greater risk of VTEs compared with BPS-treated patients. CL-treated patients also tend to experience a VTE within the first month after cessation of oral administration.

scholarly journals Distal-to-Snuffbox Arteriovenous Fistula

2018 ◽  
Vol 27 (04) ◽  
pp. 227-231 ◽  
Author(s):  
Dale Maharaj ◽  
Rayaad Baksh ◽  
Adedapo Oladiran ◽  
Emerson Budhoo ◽  
Michael Ramdass
Keyword(s):  
Arteriovenous Fistula ◽  
Primary Patency ◽  
Cephalic Vein ◽  
Success Rates ◽  
Extensor Pollicis Longus ◽  
Proper Patient Selection ◽  
Previous Trauma ◽  
Stage Renal Disease ◽  
End Stage

AbstractThe dogma for optimal arteriovenous fistula (AVF) creation is based on starting as distally as possible on the upper limb and progressing proximally. We herein present our findings of an AVF that is as distal as possible on the hand. To document primary patency rates of the distal-to-snuffbox AVF. A 10-year prospective study (2006–2016) involving 31 patients whose distal cephalic vein diameter was ≥3 mm with a normal Allen's test was conducted. Patients were excluded if the radial artery in the wrist was highly calcified, the cephalic vein did not dilate more than 3 mm with proximal compression, and there was previously failed AVF of the limb or previous trauma to the limb. The procedure was performed under local anesthetic, and the anastomosis performed with a 6.0 polypropylene suture in an end-to-side fashion. Thirty-one patients with end-stage renal disease underwent distal vascular access using the distal-to-snuffbox (Hitchhiker's) AVF (HAVF). During follow-up, eight patients died with an adequately functioning HAVF. The primary patency rates at 12, 24, 48, and 60 months were 90, 87, 85, and 82%, respectively. Failure occurred in six (19%) cases over the follow-up period, two in the first 2 weeks and four over a span of 60 months. Conclusion The creation of radiocephalic AVFs in the first web space, distal to the tendon of the extensor pollicis longus, serves as a viable option with acceptable success rates. This allows the surgeon more options with proper patient selection for this procedure.

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

2021 ◽  
pp. 112972982110212
Author(s):  
Ahmet Murt ◽  
Serap Yadigar ◽  
Serkan Feyyaz Yalin ◽  
Mevlut Tamer Dincer ◽  
Ergun Parmaksiz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
High Mortality ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Near Future

Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

scholarly journals Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis

2021 ◽  
Vol 14 (2) ◽  
pp. e236508
Author(s):  
Rajesh Vijayvergiya ◽  
Navjyot Kaur ◽  
Saroj K Sahoo ◽  
Ashish Sharma
Keyword(s):  
Mechanical Thrombectomy ◽  
Transluminal Angioplasty ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis

Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.

scholarly journals Living Kidney Donation: Practical Considerations on Setting Up a Program

2021 ◽  
Vol 2 (1) ◽  
pp. 75-86
Author(s):  
Maria Irene Bellini ◽  
Vito Cantisani ◽  
Augusto Lauro ◽  
Vito D’Andrea
Keyword(s):  
Good Practice ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Exchange Programs ◽  
Paired Exchange ◽  
Stage Renal Disease ◽  
End Stage ◽  
Additional Value ◽  
Work Up

Living kidney donation represents the best treatment for end stage renal disease patients, with the potentiality to pre-emptively address kidney failure and significantly expand the organ pool. Unfortunately, there is still limited knowledge about this underutilized resource. The present review aims to describe the general principles for the establishment, organization, and oversight of a successful living kidney transplantation program, highlighting recommendation for good practice and the work up of donor selection, in view of potential short- and long-terms risks, as well as the additional value of kidney paired exchange programs. The need for donor registries is also discussed, as well as the importance of lifelong follow up.

scholarly journals Vasculitis ANCA: Alternativas de tratamiento y las expectativas en los pacientes

2021 ◽  
pp. 1-2
Author(s):  
Carolina Aguilar-Martínez 
Keyword(s):  
Systematic Review ◽  
Cox Regression ◽  
Meta Analysis ◽  
Significant Risk ◽  
Limiting Factor ◽  
Significant Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Immunosuppression Therapy

<b>Background:</b> The benefits of treating anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) in advancing age remains unclear with most published studies defining elderly as ≥65 years. This study aims to determine outcomes of induction immunosuppression in patients aged ≥75 years. <b>Methods:</b> A cohort of patients aged ≥75 years with a diagnosis of AAV between 2006 and 2018 was constructed from 2 centres. Follow-up was to 2 years or death. Analysis included multivariable Cox regression to compare mortality and end-stage renal disease (ESRD) based on receipt of induction immunosuppression therapy with either cyclophosphamide or rituximab. A systematic review of outcome studies was subsequently undertaken amongst this patient group through Pubmed, Cochrane and Embase databases from inception until October 16, 2019. <b>Results:</b> Sixty-seven patients were identified. Mean age was 79 ± 2.9 years and 82% (<i>n</i> = 55) received induction immunosuppression. Following systematic review, 4 studies were eligible for inclusion, yielding a combined total of 290 patients inclusive of our cohort. The aggregated 1-year mortality irrespective of treatment was 31% (95% CI 25–36%). Within our cohort, induction immunosuppression therapy was associated with a significantly lower 2-year mortality risk (hazard ratio [HR] 0.29 [95% CI 0.09–0.93]). The pooled HR by meta-analysis confirmed this with a significant risk reduction for death (HR 0.31 [95% CI 0.16–0.57], <i>I</i><sup>2</sup> = 0%). Treated patients had a lower pooled rate of ESRD, but was not statistically significant (HR 0.71 [95% CI 0.15–3.35]). <b>Conclusion:</b> This meta-analysis suggests that patients ≥75 years with AAV do benefit from induction immunosuppression with a significant survival benefit. Age alone should not be a limiting factor when considering treatment.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background 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. Methods 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. Results 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). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

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