scholarly journals Recurrent thrombosis of an arteriovenous fistula as a complication of COVID-19 in a chronic hemodialysis patient: A case report

2021 ◽  
pp. 112972982110008
Author(s):  
Joao Pedro Teixeira ◽  
Sara A Combs ◽  
Jonathan G Owen
Keyword(s):  
Arteriovenous Fistula ◽  
Hemodialysis Patient ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Chronic Hemodialysis ◽  
Risk Of Death ◽  
Catheter Directed Thrombolysis ◽  
Intravenous Heparin ◽  
Increased Risk ◽  
End Stage

Patients with end-stage kidney disease are at increased risk of death from coronavirus disease 2019 (COVID-19). In addition, severe COVID-19 has been associated with an increased risk of arterial and venous thromboses. In this report, we describe the case of a hemodialysis patient who developed an otherwise-unexplained thrombosis of an arteriovenous fistula during a symptomatic COVID-19 infection. Despite prompt treatment with three technically successful thrombectomies along with systemic intravenous heparin and two rounds of catheter-directed thrombolysis with tissue plasminogen activator, the fistula rapidly re-thrombosed each time and he required tunneled dialysis catheter placement. He subsequently required admission for hypoxemia from COVID-19 pneumonia and ultimately developed a catheter-related blood stream infection that likely contributed to his death. As the fistula had been previously well functioning and no angiographic explanation for the thrombosis was found, we speculate in this case the recurrent thromboses were related to the hypercoagulable state characteristic of severe COVID-19. Interventionalists performing hemodialysis access procedures should be aware of the prothrombotic state associated with COVID-19 and should consider it when deliberating how to best plan and approach access interventions in patients with symptomatic COVID-19.

Anatomical variations in upper arm vasculature pertinent to haemodialysis access creation: are surgeons aware sufficiently?

2020 ◽  
pp. 1-14
Author(s):  
Zia Ur Rehman ◽  
Zainab Majid ◽  
Laila Tul Qadar ◽  
Aamina Majid
Keyword(s):  
Arteriovenous Fistula ◽  
Brachial Artery ◽  
End Stage Renal Disease ◽  
Anatomical Variations ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Increased Risk ◽  
Brachial Vein ◽  
Stage Renal Disease ◽  
End Stage

Abstract There exist wide anatomical variations of upper limb. Their implication is perhaps greatest when it comes to failure of arteriovenous fistula (AVF) for chronic hemodialysis. Among arteries of forearm, brachial artery is of note, whose high bifurcation is associated with increased risk of failure. The superficial and accessory variants also cause difficulty for the surgeon. The single unpaired brachial vein and stenosis of cephalic vein compound the difficulties associated with AVF among many others. A thorough understanding of surgeons regarding normal anatomy and diverse variants holds high importance in context of deciding an appropriate site for arteriovenous (AV) anastomosis. Negligence in creation of fistula not only pose a threat to patients of end stage renal disease (ERSD) but also contributes to numerous other complications involving nerves and drug administration. Keywords: Brachial artery; basilic vein; arteriovenous fistula; vascular variations. Continuous....

scholarly journals Co-prevalent infections in adults with HIV-associated cryptococcal meningitis are associated with an increased risk of death: a nested analysis of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) cohort

2021 ◽  
Vol 6 ◽  
pp. 19
Author(s):  
Jayne Ellis ◽  
Newton Kalata ◽  
Eltas Dziwani ◽  
Agnes Matope ◽  
Duolao Wang ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Opportunistic Infections ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Sub Saharan Africa ◽  
Attributable Mortality ◽  
Retrospective Case ◽  
Risk Of Death ◽  
Increased Risk ◽  
Hospital Acquired

Background: HIV-associated cryptococcal meningitis accounts for 15% of AIDS related deaths globally. In sub-Saharan Africa, acute mortality ranges from 24% to 100%. In addition to the mortality directly associated with cryptococcosis, patients with HIV-associated cryptococcal meningitis are at risk of a range of opportunistic infections (OIs) and hospital acquired nosocomial infections (HAIs). The attributable mortality associated with co-prevalent infections in cryptococcal meningitis has not been evaluated. Methods: As part of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) trial, consecutive HIV-positive adults with cryptococcal meningitis were randomised to one of five anti-fungal regimens and followed up until 10-weeks. We conducted a retrospective case note review of ACTA participants recruited from Queen Elizabeth Central Hospital in Blantyre, Malawi to describe the range and prevalence of OIs and HAIs diagnosed, and the attributable mortality associated with these infections. Results: We describe the prevalence of OIs and HAIs in 226 participants. Baseline median CD4 count was 29 cell/mm3, 57% (129/226) were on anti-retroviral therapy. 56% (127/226) had at least one co-prevalent infection during the 10-week study period. Data were collected for 187 co-prevalent infection episodes. Suspected blood stream infection was the commonest co-prevalent infection diagnosed (34/187, 18%), followed by community-acquired pneumonia (32/187, 17%), hospital-acquired pneumonia (13/187, 7%), pulmonary tuberculosis (12/187, 6%) and confirmed blood stream infections (10/187, 5%). All-cause mortality at 10-weeks was 35% (80/226), diagnosis of an OI or HAI increased the risk of death at 10 weeks by nearly 50% (HR 1.48, 95% CI 1.01-2.17, p=0.04). Conclusion: We demonstrate the high prevalence and broad range of OIs and HAIs occurring in patients with HIV-associated cryptococcal meningitis. These co-prevalent infections are associated with a significantly increased risk of death. Whether a protocolised approach to improve surveillance and proactive treatment of co-prevalent infections would improve cryptococcal meningitis outcomes warrants further investigation.

scholarly journals Colistin Induced Neurotoxicity in a Patient with End Stage Kidney Disease and Recovery with Conventional Hemodialysis

2015 ◽  
Vol 8 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Radhika Chemmangattu Radhakrishnan ◽  
Shibu Jacob ◽  
Harish Ratnakarrao Pathak ◽  
Veerasami Tamilarasi
Keyword(s):  
Bacterial Infections ◽  
Blood Stream Infection ◽  
Signs And Symptoms ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
End Stage Kidney Disease ◽  
Neurotoxic Effects ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis

Colistin is widely used in the treatment of multidrug resistant bacterial infections. Nephrotoxicity and neurotoxicity are risks associated with colistin use. We report the case of a 50 year old lady with end stage renal disease, treated with colistin for catheter related blood stream infection and developed muscle weakness and parasthesia. Concomitant use of meropenem may have precipitated neurotoxicity of colistin. Conventional hemodialysis was effective in reversing her signs and symptoms. Clinicians should be aware of the risk of neurotoxicity while using colistin, especially after a loading dose in patients with renal impairment. According to our knowledge, this is the first report of conventional hemodialysis reversing the neurotoxic effects of colistin.

scholarly journals Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant

2020 ◽  
Vol 14 (04) ◽  
pp. 408-410 ◽  
Author(s):  
Muhammed Rasid Aykota ◽  
Tugba Sari ◽  
Sevda Yilmaz
Keyword(s):  
Liver Transplantation ◽  
Acinetobacter Baumannii ◽  
Blood Stream Infection ◽  
Organ Transplant ◽  
Drug Resistant ◽  
Biliary Leakage ◽  
Cadaveric Donor ◽  
Donor Liver Transplantation ◽  
Increased Risk ◽  
End Stage

Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, Acinetobacter baumannii infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation. The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. A. baumannii was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery. The duration of a transplant patient’s hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) A. baumannii infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.

scholarly journals Intracardiac fistula: an unusual complication of catheter-related blood stream infection

JRSM Open ◽  
2017 ◽  
Vol 8 (9) ◽  
pp. 205427041772823 ◽  
Author(s):  
Abhilash Koratala ◽  
Hussain Aboud ◽  
Robert Gibson ◽  
Karen K Hamilton
Keyword(s):  
End Stage Renal Disease ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Blood Stream ◽  
Unusual Complication ◽  
Early Use ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

Lesson In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

2020 ◽  
Vol 51 (6) ◽  
pp. 424-432 ◽  
Author(s):  
Salina P. Waddy ◽  
Adan Z. Becerra ◽  
Julia B. Ward ◽  
Kevin E. Chan ◽  
Chyng-Wen Fwu ◽  
...  
Keyword(s):  
The United States ◽  
Future Research ◽  
Dialysis Patients ◽  
Mortality And Morbidity ◽  
Medication Prescription ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

scholarly journals Alteration autonomic control of cardiac function during hemodialysis predict cardiovascular outcomes in end stage renal disease patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chih-Chin Kao ◽  
Chi-Ho Tseng ◽  
Men-Tzung Lo ◽  
Ying-Kuang Lin ◽  
Chien-Yi Hsu ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Chronic Hemodialysis ◽  
Autonomic Control ◽  
Prognostic Indicators ◽  
Atherosclerotic Cardiovascular Disease ◽  
Control Mechanisms ◽  
Hemodynamic Parameters ◽  
Increased Risk ◽  
End Stage ◽  
Esrd Patients

AbstractDialysis-induced hemodynamic instability has been associated with increased risk of cardiovascular (CV) mortality. However, the control mechanisms beneath the dynamic BP changes and cardiac function during hemodialysis and subsequent CV events are not known. We hypothesize that the impaired hemodynamic control can be prognostic indicators for subsequent CV events in end stage renal diseaes (ESRD) patients. To explore the association of hemodynamic parameters and CV events in hemodialysis patients, we enrolled ESRD patients who received chronic hemodialysis without documented atherosclerotic cardiovascular disease and hemodynamic parameters were continuously obtained from the impedance cardiography during hemodialysis. A total of 35 patients were enrolled. 16 patients developed hospitalized CV events. The statistical properties [coefficient of variance (standard deviation / mean value; CoV)] of hourly beat-to-beat dynamics of hemodynamic parameters were calculated. The CoV of stroke volume (SV) and cardiac index (CI) between the 1st and 2nd hour of dialysis were significantly increased in patients without CV events compared to those with CV events. Higher CoV of SVdiff and CIdiff were significantly correlated with longer CV event-free survival, and the area under the receiver operating characteristic (ROC) curve showed fair overall discriminative power (0.783 and 0.796, respectively). The responses of hemodynamic control mechanisms can be independent predictive indexes for lower hospitalized CV events, which implies that these patients who have better autonomic control systems may have better CV outcomes.

Bilateral brachiocephalic vein stenosis in a chronic hemodialysis patient with well-functioning arteriovenous fistula – A rare entity

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
MAJ GEN SINGH ◽  
VINOD KUMAR
Keyword(s):  
Arteriovenous Fistula ◽  
Young Female ◽  
Chronic Hemodialysis ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Chronic Hemodialysis Patient ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis ◽  
Central Vein Stenosis

<b>Introduction:</b> Central vein stenosis has been reported in patients of end stage renal disease with subclavian vein being more commonly affected than brachiocephalic vein. <br><b>Case report:</b> We present a case of young female with bilateral brachiocephalic vein obstruction following arteriovenous fistula creation for hemodialysis.

Clostridium difficile infection in dialysis patients

2016 ◽  
Vol 65 (2) ◽  
pp. 353-357 ◽  
Author(s):  
Ankita Tirath ◽  
Sandra Tadros ◽  
Samuel L Coffin ◽  
Kristina W Kintziger ◽  
Jennifer L Waller ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
The United States ◽  
Hiv Positive ◽  
Adjusted Relative Risk ◽  
Dialysis Patients ◽  
Risk Of Death ◽  
Nosocomial Diarrhea ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI have increased mortality, longer length of stay, and higher costs. The present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. We queried the United States Renal Data System (USRDS) for patients with ESRD diagnosed with CDI, and assessed for the incidence of infection, comorbidities, and mortality. The records of 419,875 incident dialysis patients from 2005 to 2008 were reviewed. 4.25% had a diagnosis of a first CDI. In the majority of patients with CDI positive, a hospitalization or ICU stay was documented within 90 days prior to the diagnosis of CDI. The greatest adjusted relative risk (aRR) of CDI was present in patients with HIV (aRR 2.68), age ≥65 years (aRR 1.76), and bacteremia (aRR 1.74). The adjusted HR (aHR) for death was 1.80 in patients with CDI. The comorbidities demonstrating the greatest risk for death in dialysis patients with CDI included age ≥65 years and cirrhosis (aHR 2.28 and 1.76, respectively). Recurrent CDI occurred in 23.6%, was more common in Caucasians, and in those who were older. CDI is a common occurrence in patients with ESRD, with elderly patients, patients with HIV positive, and bacteremic patients at highest risk for infection. Patients with CDI had nearly a twofold increased risk of death.

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