Overlapping stent insertion for a treatment-resistant seroma after arteriovenous fistulation using prosthetic grafts

2021 ◽  
pp. 112972982110270
Author(s):  
Miju Bae ◽  
Chang Ho Jeon ◽  
Chung Won Lee ◽  
Up Huh ◽  
Moran Jin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Present Report ◽  
Radial Force ◽  
Stent Insertion ◽  
Treatment Resistant ◽  
Short Bowel ◽  
Alternative Plan ◽  
Arterial Anastomosis ◽  
Surgical Treatments

An arteriovenous fistula was required for permanent vascular access in a patient undergoing hemodialysis due to progressive chronic kidney disease associated with short bowel syndrome. In the present report, we discuss the case of a patient who underwent arteriovenous grafting because there was no proper native vein as a route, following which a seroma developed near the arterial anastomosis. Despite several surgical treatments, seroma not only recurred but also affected dialysis by compressing the graft. A stent was inserted into the graft to withstand the pressure from the seroma, and because one stent could not withstand the pressure, the stent overlapped where it received the most compression. Since then, the patency of graft has been well maintained for more than 2 years. Increasing the radial force of overlapping stents would be an alternative plan to help solve the problematic repeated compressible seroma despite multiple surgical treatments.

scholarly journals Drug information update. Lithium and chronic kidney disease: Debates and dilemmas

2017 ◽  
Vol 41 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Sumeet Gupta ◽  
Udayan Khastgir
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Research Evidence ◽  
Evidence Base ◽  
Current Evidence ◽  
Treatment Resistant ◽  
The Past ◽  
Current Evidence Base ◽  
Information Update ◽  
Resistant Depression

SummaryLithium is an established treatment for bipolar disorder and an augmenting agent for treatment-resistant depression. Despite awareness of renal adverse effects, including chronic kidney disease, for the past five decades, there has been a lack of research evidence. This has led to debates around the existence and magnitude of the risk. This article discusses the current evidence base regarding the link between lithium and chronic kidney disease, monitoring of renal functions and its clinical implications.

scholarly journals Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

2019 ◽  
Vol 32 (9) ◽  
pp. 858-867 ◽  
Author(s):  
Roy O Mathew ◽  
Jerome Fleg ◽  
Janani Rangaswami ◽  
Bo Cai ◽  
Arif Asif ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Treatment Resistant ◽  
Advanced Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

AbstractBACKGROUNDCentral arteriovenous fistula (cAVF) has been investigated as a therapeutic measure for treatment-resistant hypertension in patients without advanced chronic kidney disease (CKD). There is considerable experience with the use of AVF for hemodialysis in patients with end-stage renal disease (ESRD). However, there is sparse data on the blood pressure (BP) effects of an AVF among patients with ESRD. We hypothesized that AVF creation would significantly reduce BP compared with patients who did not have an AVF among patients with ESRD before starting hemodialysis.METHODSBPs were compared during the 12 months before hemodialysis initiation in 399 patients with an AVF or AV graft created and 4,696 patients without either.RESULTSAfter propensity score matching 1:2 ratio (AVF to no AVF), repeated measures analysis of variance revealed significant reductions of –1.7 mm Hg systolic and –3.9 mm Hg diastolic BP 12 months in patients after AVF creation; P = 0.025 and P < 0.001, respectively, compared with those with no AVF.CONCLUSIONSThese findings suggest that AVF creation results in modest BP reduction in patients with pre-dialysis ESRD who require AVF for eventual hemodialysis therapy. Preferential diastolic BP reduction suggests that greater work is needed to characterize the ideal patient subset in which to use cAVF for treatment-resistant hypertension in those without advanced CKD.

scholarly journals Inflammation and Apparent Treatment-Resistant Hypertension in Patients With Chronic Kidney Disease

Hypertension ◽  
2019 ◽  
Vol 73 (4) ◽  
pp. 785-793 ◽  
Author(s):  
Jing Chen ◽  
Joshua D. Bundy ◽  
L. Lee Hamm ◽  
Chi-yuan Hsu ◽  
James Lash ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Treatment Resistant

scholarly journals Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease

Hypertension ◽  
2016 ◽  
Vol 67 (2) ◽  
pp. 387-396 ◽  
Author(s):  
George Thomas ◽  
Dawei Xie ◽  
Hsiang-Yu Chen ◽  
Amanda H. Anderson ◽  
Lawrence J. Appel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Disease ◽  
Treatment Resistant ◽  
Mortality Hazard ◽  
All Cause Mortality ◽  
Peripheral Arterial ◽  
Mortality Hazard Ratio

The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure ≥140/90 mm Hg on ≥3 antihypertensives, or use of ≥4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRH—composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22–1.56]); renal events (1.28 [1.11–1.46]); CHF (1.66 [1.38–2.00]); and all-cause mortality (1.24 [1.06–1.45]). The subset of participants with ATRH and blood pressure at goal on ≥4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12–1.51]) and CHF (1.59 [1.28–1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate ≥30 mL/min per 1.73 m 2 . Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

Chronic kidney disease and kidney stone risk factors in adult patients with short bowel syndrome

2018 ◽  
Vol 37 ◽  
pp. S67
Author(s):  
E. Letavernier ◽  
S. Vandermeersch ◽  
V. Boehm ◽  
L. Billiauws ◽  
F. Joly
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Short Bowel Syndrome ◽  
Kidney Stone ◽  
Adult Patients ◽  
Short Bowel

Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Jean Jacques Noubiap ◽  
Jobert Richie Nansseu ◽  
Ulrich Flore Nyaga ◽  
Paule Sandra Sime ◽  
Innocent Francis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
White Coat Hypertension ◽  
Reference List ◽  
Treatment Resistant ◽  
New Treatments ◽  
Q Statistic

ObjectiveWe conducted the first systematic review and meta-analysis to estimate the specific prevalence of apparent treatment-resistant, pseudo-resistant and true-resistant hypertension among treated patients with hypertension globally.MethodsWe conducted a search in PubMed, EMBASE, Web of Science and Global Index Medicus to identify articles published from inception to 30 September 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the prevalence of resistant hypertension across studies and heterogeneity was assessed via the χ² test on Cochran’s Q statistic.ResultsWe included 91 studies published between 1991 and 2017 reporting data of a pooled sample of 3 207 911 patients with hypertension on antihypertensive drugs globally. Most of the studies (n=64, 70%) only used office blood pressure (BP) measurement. In the general, population of treated patients with hypertension, the prevalence of true-resistant, apparent treatment-resistant and pseudo-resistant hypertension were 10.3% (95% CI 7.6% to 13.2%), 14.7% (95% CI 13.1% to 16.3%) and 10.3% (95% CI 6.0% to 15.5%). The prevalence of true-resistant hypertension was 22.9% (95% CI 19.1% to 27.0%), 56.0% (95% CI 52.7% to 59.3%) and 12.3% (95% CI 1.7% to 30.5%) in chronic kidney disease, renal transplant and elderly patients, respectively.ConclusionsThis study shows a high prevalence of true-resistant hypertension. This prevalence is lower than that of apparent treatment-resistant hypertension, demonstrating the importance to exclude causes of pseudo-resistant hypertension including white-coat hypertension with the use of ambulatory BP measurement. The burden of resistant hypertension is highest in patients with chronic kidney disease. New treatments for resistant hypertension are highly needed, considering the disastrous complications of the disease.

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