scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

scholarly journals Haemodialysis vascular access: current practices amongst Indian nephrologists

2018 ◽  
Vol 19 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Dinesh Bansal ◽  
Vijay Kher ◽  
Krishan Lal Gupta ◽  
Debasish Banerjee ◽  
Vivekanand Jha
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Vascular Access ◽  
Average Cost ◽  
Online Survey ◽  
Current Status ◽  
Dialysis Patients ◽  
Conservative Care ◽  
Access Services

Introduction: Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. Methods: An online survey was emailed to 920 Indian nephrologists and 388 (42.1%) responded; 98.5% of whom were responsible for managing dialysis patients, 98% in hospitals. Results: Sixty-four percent of patients initiated renal replacement therapy with HD, 7% with peritoneal dialysis, 10% kidney transplantation and 19% conservative care. Forty-eight percent of patients were self-paying, 26% had employee reimbursement and 23% had insurance. According to 59% of responders, more than three-quarters of patients started dialysis with uncuffed catheter, less than one-quarter started dialysis with fistula; and very few used grafts or tunnelled catheters. Among prevalent HD patients, over half were dialysing with fistula (79% nephrologists), rather than uncuffed catheters (15% nephrologists) or grafts (<1% nephrologists). Sixteen percent reported at least one catheter-related sepsis in more than half of patients. Placement of uncuffed catheters cost US$160 in 92% facilities, whereas tunnelled catheters cost US$320 in 46% of facilities. An arteriovenous fistula (AVF) could be created for US$160 in 40%, and US$320 in 90% of centres. Thirty-five percent of nephrologists reported that grafts were not placed at their institute and where they were available, the average cost was over US$480. Forty-six percent of nephrologists had access to pre-dialysis clinics, <30% to vascular access programmes, and <17% conducted regular vascular access audits. Conclusions: The survey provides a snapshot of the current status of vascular access care in HD patients and highlights need for pre-dialysis clinics, vascular access services and registry audits.

scholarly journals Blood Loss through AV Fistula: A Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Fahad Saeed ◽  
Nadia Kousar ◽  
Ramapriya Sinnakirouchenan ◽  
Vijaya S. Ramalingam ◽  
Philip B. Johnson ◽  
...  
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Vascular Access ◽  
Blood Transfusions ◽  
Dialysis Access ◽  
Dialysis Catheter ◽  
Acute Blood Loss ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access

Little has been written about acute blood loss from hemodialysis vascular access. We describe a 57-year-old Caucasian male with an approximately 7 gm/dL drop in hemoglobin due to bleeding from a ruptured aneurysm in his right brachiocephalic arteriovenous fistula (AVF). There was no evidence of fistula infection. The patient was successfully managed by blood transfusions and insertion of a tunneled dialysis catheter for dialysis access. Later, the fistula was ligated and a new fistula was constructed in the opposite arm. Aneurysm should be considered in cases of acute vascular access bleeding in chronic dialysis patients.

scholarly journals MO887THE IMPACT OF A MULTI-DISCIPLINARY CLINIC ON THE OUTCOMES OF INCIDENT DIALYSIS PATIENTS IN A REGIONAL HOSPITAL IN SINGAPORE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boon Cheok Lai ◽  
Mayank Chawla ◽  
Shashidahar Baikunje ◽  
Lee Ying Yeoh ◽  
Marie Tan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Group Versus ◽  
Dialysis Initiation ◽  
Conventional Group ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Care Clinic ◽  
Number Of Patients ◽  
Initiation Of Dialysis

Abstract Background and Aims Institution of a pre-dialysis programme has been shown to improve the outcome of the chronic kidney disease (CKD) patients approaching end stage renal disease (ESRD). A renal multidisciplinary clinic (MDC) aimed at reducing unprepared dialysis initiation is known to reduce morbidity in such patients and reduce the risks of complications once the patient initiates dialysis. The design of this service is of paramount importance to ensure efficient delivery and to achieve optimal utilization of the resources. The number of patients requiring urgent initiation of dialysis is alarmingly high in Singapore as compared to elective initiation, and our hospital was no exception when we started the renal service in 2018. Patients with unplanned initiation of RRT either because of lack of referral/late referral, infrequent follow up with the nephrologist or because of other factors such as inadequate knowledge of disease trajectory, or poor compliance to medications, tended to have worse outcomes. Method We recruited the patient who initiated dialysis between July 2018 to July 2020 in our Quality Improvement (QI) project. In the MDC group, the patient will be reviewed by a dedicated team of nephrologists, renal coordinators (RC) and medical social workers (MSW) and comprises of 2 mutually exclusive components: low clearance clinic (LCC) and transitional care clinic (TCC). In the MDC, nephrologist takes a lead role for the patient’s overall medical assessment and treatment. Renal coordinator provides the CKD and dialysis education to empower patient to make the correct RRT choice. MSW provides psychosocial support and financial counselling. The LCC became operational from 07th September 2018 while the TCC was initiated on 12th July 2019. CKD patients who are deemed likely to need RRT in the coming one year by the primary nephrologist are scheduled to attend LCC. Upon initiation of haemodialysis, all patients are referred to the TCC in the first month of their discharge. In the conventional group, we recruited the patient who have not attended MDC before or after dialysis initiation. Retrospectively, their data including baseline demographic and morbidity parameters were collected in the MDC group and conventional group. Morbidity outcome like definitive dialysis access, needs of intensive care unit (ICU) admissions, complications like catheter related blood stream infections (CRBSI) and other infections, stroke and myocardial infarction (MI) were analysed. Results There are 130 patients initiated on RRT between July 2018 to July 2020. The percentage of patient started dialysis with a definitive access was greater in the MDC group (25%) as compared to the conventional group (9%) (p=0.03). Although statistically not significant, the incidence of intensive care unit (ICU) admission was also lower in the MDC group (10%) than the conventional group (31%) (p=0.06). After initiation of dialysis, the patients in the MDC group had lower rates of CRBSI (5.6%) than the conventional group (14%) (p=0.17). These patients also had lower rates of other infections and major adverse cardiovascular outcomes (13% in MDC group versus 37% in conventional group) (p=002). The rate of recurrent admission, defined as frequent admissions up to 3 times per year, was lower as well in the MDC group (13%) as compared to the conventional group (35%) (p=0.003). Conclusion This QI project has demonstrated the benefit of MDC in improving the lives of the incident dialysis patients. Moving forward, we aim to continue to evolve this clinic in order to match the changing needs of our patients, with a view to increase its uptake, and to increase the percentage of patients having elective starts with a definitive dialysis access to at least 65% as per target set in NKF-KDOQI 2009 guidelines, in order to help them achieve the maximum benefit out of this endeavour.

scholarly journals Dialysis access as a source of infective endocarditis in dialysis patients

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Hee D. Jeon ◽  
Kevin B. Lo ◽  
Eduardo E. Quintero ◽  
Byeori Lee ◽  
Asma Gulab ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Vascular Access ◽  
Medical Center ◽  
Bacterial Invasion ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Access Site ◽  
Source Of Infection ◽  
Duke Criteria ◽  
Increased Risk

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft?

2019 ◽  
Vol 21 (1) ◽  
pp. 7-18 ◽  
Author(s):  
Nicholas Inston ◽  
Aurangzaib Khawaja ◽  
Hiren Mistry ◽  
Robert Jones ◽  
Domenico Valenti
Keyword(s):  
Vascular Access ◽  
Treatment Options ◽  
Venous Catheter ◽  
Right Atrial ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Arterial Access ◽  
Secondary Patency Rate ◽  
Number Of Patients ◽  
End Stage

Background: Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options. Three options for patients with end stage access are a central venous catheter through a translumbar or transhepatic route, arterial-arterial prosthetic loop or a right atrial graft. Aims: The aims of this study are to provide a structured review of evidence for these procedures to allow application and guide practice for patients with end stage vascular access. Methods: A standardised search of published literature was performed of relevant studies. In addition, the references cited in those papers were assessed for any further available articles. All study types were included and reviewed by two authors independently. Primary outcomes were patient survival and secondary patency rate at 3 and 12 months. Secondary outcomes were long-term patency rates, mean time to cannulation and complications such as access dysfunction, thrombosis and infection. Summary: Based on the available evidence, it would appear that arterial-arterial prosthetic loop is a definitive option for maintaining dialysis access in patients with no more arteriovenous access options. Translumbar and transhepatic dialysis catheters may offer short- and medium-term options and right atrial grafts may also be suitable as an option where arterial-arterial prosthetic loop is unsuitable.

scholarly journals Increasing the Hematocrit Has a Beneficial Effect on Quality of Life and Is Safe in Selected Hemodialysis Patients

2000 ◽  
Vol 11 (2) ◽  
pp. 335-342
Author(s):  
FUENSANTA MORENO ◽  
DÁMASO SANZ-GUAJARDO ◽  
JUAN MANUEL LÓPEZ-GÓMEZ ◽  
ROSA JOFRE ◽  
FERNANDO VALDERRÁBANO
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Functional Status ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Uncontrolled Hypertension ◽  
Cumulative Probability ◽  
Dialysis Patients ◽  
Number Of Patients

Target hematocrit/hemoglobin values in dialysis patients are still controversial. The Spanish Cooperative Renal Patients Quality of Life Study Group (including 34 hemodialysis units) conducted a prospective, 6-mo study of the effect on patient functional status and quality of life of using epoetin to achieve normal hematocrit in hemodialysis patients with anemia. The possible adverse effects of increased hematocrit, patient hospitalization, and epoetin requirements were also studied. The study included 156 patients (age range, 18 to 65 yr). Given the minimal experience in the safety of increasing hematocrit in dialysis patients to normal levels with epoetin, stable patients on hemodialysis who had received epoetin treatment for at least 3 mo and had a stable hemoglobin level of ≥9 g/dl were included in the study. Patients with antecedents of congestive cardiac failure, ischemic cardiopathy, diabetes mellitus, uncontrolled hypertension, cerebrovascular accident or seizures, malfunction of the vascular access or severe comorbidity (defined by a comorbidity index), and those over 65 yr of age were excluded from the study. Quality of life was measured with the Sickness Impact Profile (SIP) and Karnofsky scale. Patients completed questionnaires at home at onset and conclusion of the 6-mo study. Mean hematocrit increased from 30.9 to 38.4% and hemoglobin from 10.2 to 12.5 g/dl during the study. Health indicator scores improved significantly: mean Physical Dimension (SIP) from 5.38 to 4.1 (P < 0.005); mean Psychosocial Dimension from 9.2 to 7 (P < 0.001); mean global SIP from 8.9 to 7.25 (P < 0.001); mean Karnofsky scale score from 75.6 to 78.4 (P < 0.01). (SIP is scaled so that lower scores represent better functional status, and vice versa for the Karnofsky scale). Therefore, functional status and quality of life improved with increased hematocrit. No deaths occurred. Three patients (2%) were censored for hypertension and nine (5.7%) for thrombosis of the vascular access. The cumulative probability of thrombosis of the vascular access was 0.067. The average epoetin dose rose from 93 ± 62 U/kg per wk at onset to 141 ± 80 U/kg per wk at conclusion, a 51% increase. The number of patients hospitalized decreased and hospital lengths of stay were shorter during the study period than in the same patients in the 6-mo period preceding the study (P < 0.05). Nine patients (5.7%) had thrombosis of the vascular access. There were no changes in the prevalence of arterial hypertension, but three patients (2%) showed hypertension that was difficult to control. It is concluded that normalization of hematocrit in selected hemodialysis patients, i.e., nondiabetic patients without severe cardiovascular or cerebrovascular comorbidities, improves quality of life and decreases morbidity without significant adverse effects.

Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

2018 ◽  
Vol 10 (2) ◽  
pp. 20204
Author(s):  
Laetitia Idier ◽  
Aurélie Untas ◽  
Nicole Rascle ◽  
Michèle Koleck ◽  
Maider Aguirrezabal ◽  
...  
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Vascular Access ◽  
Educational Program ◽  
Psychological State ◽  
Control Group ◽  
Dialysis Patients ◽  
Emotional Change ◽  
The Impact ◽  
Experimental Group

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p < 0.01) and depressive symptoms increased in the experimental group (p < 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

Age- and sex-related bone uptake of Tc-99m-HDP measured by whole-body bone scanning

2000 ◽  
Vol 39 (05) ◽  
pp. 127-132 ◽  
Author(s):  
Nicole Sieweke ◽  
K. H. Bohuslavizki ◽  
W. U. Kampen ◽  
M. Zuhayra ◽  
M. Clausen ◽  
...  
Keyword(s):  
Whole Body ◽  
Bone Lesions ◽  
Men And Women ◽  
Bone Uptake ◽  
Normal Bone ◽  
Age Related ◽  
Number Of Patients ◽  
Wide Range ◽  
Bone Scans ◽  
Body Bone

Summary Aim of this study was to validate a recently introduced new and easy-to-perform method for quantifying bone uptake of Tc-99m-labelled diphosphonate in a routine clinical setting and to establish a normal data base for bone uptake depending on age and gender. Methods: In 49 women (14-79 years) and 47 men (6-89 years) with normal bone scans as well as in 49 women (33-81 years) and 37 men (27-88 years) with metastatic bone disease whole-body bone scans were acquired at 3 min and 3-4 hours p.i. to calculate bone uptake after correction for both urinary excretion and soft tissue retention. Results: Bone uptake values of various age-related subgroups showed no significant differences between men and women (p >0.05 ). Furthermore, no differences could be proven between age-matched subgroups of normals and patients with less than 10 metastatic bone lesions, while patients with wide-spread bone metastases revealed significantly increased uptake values. In both men and women highest bone uptake was obtained (p <0.05 ) in subjects younger than 20 years with active epiphyseal growth plates. In men, bone uptake slowly decreased with age up to 60 years and then showed a tendency towards increasing uptake values. In women, the mean uptake reached a minimun in the decade 20-29 years and then slowly increased with a positive linear correlation of age and uptake in subjects older than 55 years (r = 0.57). Conclusion: Since the results proposed in this study are in good agreement with data from literature, the new method used for quantification could be validated in a large number of patients. Furthermore, age- and sexrelated normal bone uptake values of Tc-99m-HDP covering a wide range of age could be presented for this method as a basis for further studies on bone uptake.

DETERMINING OF MONOCLONAL GAMMOPATHY IN NEPHROLOGICAL PATIENTS

2019 ◽  
Vol 23 (2) ◽  
pp. 82-90
Author(s):  
L. B. Lysenko ◽  
N. V. Chebotareva ◽  
N. N. Mrykhin ◽  
V. V. Rameev ◽  
T. V. Androsova ◽  
...  
Keyword(s):  
Renal Diseases ◽  
Chronic Glomerulonephritis ◽  
Al Amyloidosis ◽  
Hematological Neoplasms ◽  
Cast Nephropathy ◽  
Number Of Patients ◽  
Light Chain Disease ◽  
Kidney Involvement ◽  
Cryoglobulinemic Glomerulonephritis ◽  
Electrophoresis Of Proteins

BACKGROUND. Мonoclonal gammopathy (MG) is not only the state preceding of hematological neoplasms, but also associated with non- hematological diseases, in particular damage of kidneys. Earlier diagnosis of MG represents an important area in treating patients with renal diseases associated with MG. THE AIM: To determine the frequency of MG among therapeutic and nephrological patients for optimization of methods of their diagnosis and treatment. PATIENTS AND METHODS: In common, 11392 patients were analyzed within 4 years (2013-2016). The standard clinical examination was conducted. Method of an electrophoresis of proteins of serum of blood and the 24-hour urine, method of immunofixation of proteins of serum and urine, and method of free light chains definition in serum (Freelite) were used for MG identification. RESULTS: MG is diagnosed in 174 of 11392 patients: 49 % of men and 51 % of women aged from 18 up to 85 years. MG was found 2.1 times more often in nephrological patient than in patients of therapeutic departments. Among patients of this group, AL-amyloidosis with kidney involvement was diagnosed in 41 %, cryoglobulinemic glomerulonephritis – in 18 %, chronic glomerulonephritis – in 35 %, also there was small number of patients with light chain disease and cast-nephropathy. 86 % of nephrological patients had less than 5 g/l of monoclonal protein that corresponds oligo secretory MG, and at 46 % from them – less than 1 g/l, other 10 % had MG of 5-10 g/l, and only in 4.42 % of patients MG more 10g/l was defined. CONCLUSION: We conclude that MG, especially oligo secretory form, play a significant role in pathogenesis of renal damage. It is important to apply sensitive methods – immunofixation of proteins and method «Freelite» for nephrological patients.

Current Status and Future Perspective for Research on Medicinal Plants with Anticancerous Activity and Minimum Cytotoxic Value

2019 ◽  
Vol 20 (12) ◽  
pp. 1227-1243
Author(s):  
Hina Qamar ◽  
Sumbul Rehman ◽  
D.K. Chauhan
Keyword(s):  
Side Effects ◽  
Medicinal Plants ◽  
Anticancer Agents ◽  
Drug Targets ◽  
Psidium Guajava ◽  
Current Status ◽  
Future Perspective ◽  
Wide Range

Cancer is the second leading cause of morbidity and mortality worldwide. Although chemotherapy and radiotherapy enhance the survival rate of cancerous patients but they have several acute toxic effects. Therefore, there is a need to search for new anticancer agents having better efficacy and lesser side effects. In this regard, herbal treatment is found to be a safe method for treating and preventing cancer. Here, an attempt has been made to screen some less explored medicinal plants like Ammania baccifera, Asclepias curassavica, Azadarichta indica, Butea monosperma, Croton tiglium, Hedera nepalensis, Jatropha curcas, Momordica charantia, Moringa oleifera, Psidium guajava, etc. having potent anticancer activity with minimum cytotoxic value (IC50 >3μM) and lesser or negligible toxicity. They are rich in active phytochemicals with a wide range of drug targets. In this study, these medicinal plants were evaluated for dose-dependent cytotoxicological studies via in vitro MTT assay and in vivo tumor models along with some more plants which are reported to have IC50 value in the range of 0.019-0.528 mg/ml. The findings indicate that these plants inhibit tumor growth by their antiproliferative, pro-apoptotic, anti-metastatic and anti-angiogenic molecular targets. They are widely used because of their easy availability, affordable price and having no or sometimes minimal side effects. This review provides a baseline for the discovery of anticancer drugs from medicinal plants having minimum cytotoxic value with minimal side effects and establishment of their analogues for the welfare of mankind.

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