Understanding the Hemodynamics Involved in Ischemic Steal Syndrome of Arteriovenous Access

2019 ◽  
Vol 24 (3) ◽  
pp. 45-48
Author(s):  
Joon Ho Hong
Keyword(s):  
Significant Role ◽  
Surgical Procedures ◽  
Successful Treatment ◽  
Arteriovenous Access ◽  
Successful Outcomes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Steal Syndrome

Highlights This paper elucidates the significant role retrograde steal plays in the pathogenesis of ischemia by reviewing the successful outcomes achieved by widely employed surgical procedures. These successful interventions share an important hemodynamic feature to reverse distal ischemia: namely, the conversion of straight access configuration to a loop configuration. This conversion reduces retrograde steal, thereby increasing distal pressure and flow, resulting in the successful treatment of ischemic steal syndrome. Abstract Long-term hemodialysis, the main treatment modality for patients with end-stage renal disease, requires reliable vascular access. The arteriovenous fistula is the preferred access but remains susceptible to complications, among which ischemic steal syndrome is the most serious. The pathophysiology of ischemic steal syndrome results from the diversion of arterial flow, antegrade, retrograde, or both, into the access. Although antegrade diversion alone can cause steal syndrome, retrograde diversion plays a significant role in the development of ischemia, especially in patients with distal brachial artery-based access. Recently, the role of retrograde steal was disputed, but this paper will elucidate the significant role of retrograde steal in the pathogenesis of ischemia by reviewing the successful outcomes achieved by widely employed surgical procedures. These successful interventions share an important hemodynamic feature to reverse distal ischemia: namely, the conversion of a straight access configuration to a loop configuration. This conversion reduces retrograde steal, thereby increasing distal pressure and flow, resulting in the successful treatment of ischemic steal syndrome.

scholarly journals Significant role of renal transplantation in long-standing, end-stage renal disease

1989 ◽  
Vol 22 (5) ◽  
pp. 469-475
Author(s):  
Kunio Morozumi ◽  
Masaki Kobayashi ◽  
Ikuo Shinmura ◽  
Kazuharu Uchida ◽  
Atsuhiro Yoshida ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Disease ◽  
Significant Role ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals The Role of Tyrosine Kinase Receptors in Peritoneal Fibrosis

2015 ◽  
Vol 35 (5) ◽  
pp. 497-505 ◽  
Author(s):  
Li Wang ◽  
Shougang Zhuang
Keyword(s):  
Tyrosine Kinases ◽  
Transforming Growth Factor ◽  
Transforming Growth Factor Β1 ◽  
Peritoneal Fibrosis ◽  
Functional Changes ◽  
Ultrafiltration Failure ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is a modality for treatment of patients with end-stage renal disease (ESRD) that depends on the structural and functional integrity of the peritoneal membrane. However, long-term PD can lead to morphological and functional changes in the peritoneum; in particular, peritoneal fibrosis has become one of the most common complications that ultimately results in ultrafiltration failure (UFF) and discontinuation of PD. Several factors and mechanisms such as inflammation and overproduction of transforming growth factor-β1 have been implicated in the development of peritoneal fibrosis, but there is no effective therapy to prevent or delay this process. Recent studies have shown that activation of multiple receptor tyrosine kinases (RTKs) is associated with the development and progression of tissue fibrosis in various organs, and there are also reports indicating the involvement of some RTKs in peritoneal fibrosis. This review will describe the role and mechanisms of RTKs in peritoneal fibrosis and discuss the possibility of using them as therapeutic targets for prevention and treatment of this complication.

scholarly journals Role of Sodium Thiosulphate in Calciphylaxis

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Meshal Qaiser ◽  
◽  
Arora Kanwardeep ◽  
Keyword(s):  
Adverse Effect ◽  
Metabolic Acidosis ◽  
End Stage Renal Disease ◽  
Rare Condition ◽  
Sodium Thiosulphate ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage

Calciphylaxis, also known as Calcific Uremic Arteriolopathy (CUA), is a rare condition often but not exclusively seen in end stage renal disease. Current literature recommends trial of Sodium Thiosulphate (STS) in all CUA patients. The long - term use of STS is limited by the adverse effect of Anion Gap Metabolic Acidosis (AGMA) which can be managed timely to maximize the benefits of STS.

scholarly journals Sequence Variants of Peroxisome Proliferator-Activated Receptor-Gamma Gene and the Clinical Courses of Patients with End-Stage Renal Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Chia-Ter Chao ◽  
Yen-Ching Chen ◽  
Chih-Kang Chiang ◽  
Jenq-Wen Huang ◽  
Fu-Chang Hu ◽  
...  
Keyword(s):  
Mechanistic Study ◽  
Peroxisome Proliferator ◽  
Nucleotide Polymorphisms ◽  
Term Survival ◽  
Peroxisome Proliferator Activated Receptor ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background.PPAR-γsingle nucleotide polymorphisms (SNPs) reportedly play an important role in determining metabolic risk among diverse population. Whether PPAR-γSNPs affect the clinical courses in ESRD patients is unknown.Methods.From a multicenter cohort, we identified 698 patients with prevalent ESRD between 2002 and 2003, and other 782 healthy subjects as control. Two PPAR-γSNPs, Pro12Ala (rs1801282) and C161T (rs3856806), were genotyped and their association with ESRD was examined. Both groups were prospectively followed until 2007, and the predictability of genotypes for the long-term survival of ESRD patients was analyzed.Results.After multivariable-adjusted regression, GG genotype of Pro12Ala was significantly more likely to associate with ESRD (P<0.001) among patients with non-diabetes-related ESRD. Cox’s proportional hazard regression showed that both Pro12Ala and C161T polymorphisms were significant predictors of mortality in ESRD patients with DM (Pro12Ala: GG versus other genotypes, hazard ratio [HR] <0.01;P<0.001; for C161T, CC versus TT genotypes, HR 2.86;P<0.001; CT versus TT genotypes, HR 1.93;P<0.001).Conclusion.This is the first and largest study to evaluate PPAR-γSNPs in ESRD patients. Further mechanistic study is needed to elucidate the role of PPAR-γamong ESRD patients.

scholarly journals The Pivotal Role of Oxidative Stress in the Pathophysiology of Cardiovascular-Renal Remodeling in Kidney Disease

Antioxidants ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1041
Author(s):  
Verdiana Ravarotto ◽  
Giovanni Bertoldi ◽  
Georgie Innico ◽  
Laura Gobbi ◽  
Lorenzo A. Calò
Keyword(s):  
Oxidative Stress ◽  
Kidney Disease ◽  
Renal Injury ◽  
Renin Angiotensin System ◽  
Pivotal Role ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

The excessive activation of the renin-angiotensin system in kidney disease leads to alteration of intracellular pathways which concur altogether to the induction of cardiovascular and renal remodeling, exposing these patients since the very beginning of the renal injury to chronic kidney disease and progression to end stage renal disease, a very harmful and life threatening clinical condition. Oxidative stress plays a pivotal role in the pathophysiology of renal injury and cardiovascular-renal remodeling, the long-term consequence of its effect. This review will examine the role of oxidative stress in the most significant pathways involved in cardiovascular and renal remodeling with a focus on the detrimental effects of oxidative stress-mediated renal abnormalities on the progression of the disease and of its complications. Food for thoughts on possible therapeutic target are proposed on the basis of experimental evidences.

Putative role of KIR3DL1/3DS1 alleles and HLA-Bw4 ligands with end stage renal disease and long term renal allograft survival

Gene ◽  
2017 ◽  
Vol 637 ◽  
pp. 219-229 ◽  
Author(s):  
Swayam Prakash ◽  
Aditya Narayan Sarangi ◽  
Shahnawaz Alam ◽  
Avinash Sonawane ◽  
Raj Kumar Sharma ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Renal Allograft ◽  
Allograft Survival ◽  
Putative Role ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Modification of the HeRO Graft Allowing Earlier Cannulation and Reduction in Catheter Dependent Days in Patients with End Stage Renal Disease: A Single Center Retrospective Review

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Deirdre Hart ◽  
Christie Gooden ◽  
L. S. Cummings ◽  
Brandt C. Wible ◽  
John Borsa ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Novel Technique ◽  
Central Venous Stenosis ◽  
Arteriovenous Access ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive

After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

Frequency of Gastrointestinal Diseases in Patients with End-Stage Renal Disease Treated with Long Term Dialysis

2018 ◽  
Vol 2 (2) ◽  
pp. 105-112
Author(s):  
Lutfi Zylbeari ◽  
Zamira Bexheti ◽  
Gazmend Zylbeari ◽  
Ferizate Haxhirexha ◽  
Kastriot Haxhirexha
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Gastrointestinal Diseases ◽  
Stage Renal Disease ◽  
End Stage
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