scholarly journals Accuracy Of Spiral Laminar Flow, Spectral Broadening And Murmur / Thrill As Av-Shunt Maturuty Predictors In Dr. Mohammad Hoesin Hospital Palembang

2020 ◽  
Vol 3 (2) ◽  
pp. 138-150
Author(s):  
Kemas Muhammad Dahlan ◽  
Sefta Jaka ◽  
Jaka Fahmi ◽  
Erial Bahar
Keyword(s):  
Kidney Disease ◽  
Laminar Flow ◽  
Sensitivity And Specificity ◽  
Vascular Access ◽  
High Sensitivity ◽  
Spectral Broadening ◽  
Av Fistula ◽  
End Stage ◽  
Av Shunt ◽  
Very High

Background : Hemodialysis is a therapy for end-stage cornic kidney disease (ESRD) which is most often used as renal replacement therapy. Vascular access for hemodialysis is essential in the management of patients with chronic kidney disease. One type of vascular access is av fistula. A well-matured AVF is needed in order to function optimally during the hemodialysis process. The study of Srivastava et al. In India examined a predictor parameter of the maturation of AVF using Doppler ultrasound. The parameters studied were Spiral Laminar Flow (SLF), Spectral Broadening and Murmur / thrill. The results of this study state that SLF is the most important and early predictor of AVF maturation.5 Research on the accuracy of spiral laminar flow, spectral broadening and murmur / thrill as predictors of av-shunt maturity has never been carried out in Indonesia. This encourages this research to be carried out. Method : This type of research is the prognostic test. The study was conducted in the vascular and endovascular subdivisions from July - September 2020 or until the number of research samples is met. Result : There were 30 samples in this study, Murmur / thrill had high sensitivity and specificity values ​​on day 21 while SLF and spectral broadening had very high sensitivity and specificity values ​​in predicting AVF maturase from day 7th and 21th, also had a significant association with AVF maturase (p < 0.001). Conclusion : Murmur / thrill on 21th day can be a perdictor for maturity of AVF

scholarly journals A randomized pilot study to evaluate graft-first versus fistula-first vascular access strategy in older patients with advanced kidney disease: results of a feasibility study Pilot and Feasibility Studies

2020 ◽  
Author(s):  
Mariana Murea ◽  
Randolph L Geary ◽  
Denise K Houston ◽  
Matthew S Edwards ◽  
Todd W Robinson ◽  
...  
Keyword(s):  
Older Adults ◽  
Pilot Study ◽  
Kidney Disease ◽  
Vascular Access ◽  
Feasibility Studies ◽  
Functional Independence ◽  
Av Fistula ◽  
End Stage ◽  
Operative Assessment

Abstract Background. Although older adults encompass 40% of patients with advanced chronic kidney disease (CKD), it remains unclear which long-term hemodialysis (HD) vascular access type, arteriovenous (AV) fistula (AVF) or AV graft (AVG), is optimal with respect to effectiveness and patient satisfaction. Clinical outcomes based on the initial AV access type have not been evaluated in randomized controlled trials. This pilot study tested the feasibility of randomizing older adults with CKD to initial AVF versus AVG vascular access surgery. Methods: Patients 65 years or older with pre-dialysis CKD or incident end-stage kidney disease (ESKD) and no prior AV vascular access intervention were randomized in a 1:1 ratio to undergo surgical placement of either AVF-first or AVG-first after providing informed consent. Trial feasibility was evaluated as (i) recruitment of ≥70% of eligible participants, (ii) ≥50% to 70% of participants undergo placement of index AV access within 90 to 180 days of enrollment, respectively, (iii) ≥80% adherence to study-related assessments, and (iv) ≥70% of participants who underwent index AV access placement will have a follow-up duration of ≥12 months after index surgery date. Results: Between September 2018 and October 2019, 81% (44/54) of eligible participants consented and were enrolled in the study; 11 had pre-dialysis CKD and 33 ESKD. After randomization, 100% (21/21) assigned to AVF-first surgery and 78% (18/23) assigned to AVG-first surgery underwent index AV access placement within a median (1st, 3rd quartile) of 5.0 (1.0, 14.0) days and 13.0 (5.0, 44.3) days, respectively, after referral to vascular surgery. The completion rates for study-specific assessments ranged between 40.0 and 88.6%. At median follow-up of 215.0 days, 5 participants expired, 7 completed 12 months of follow-up, and 29 are actively being followed. Assessments of grip strength, functional independence and vascular access satisfaction were completed by >85% of patients who reached pre-specified post-operative assessment time point. Conclusions: Results from this study reveal it is feasible to enroll and randomize older adults with CKD to one of two different HD vascular access placement surgeries. The study can progress with minimum protocol adjustments to a multisite clinical trial.

scholarly journals PERSENTASE KEBERHASILAN OPERASI CIMINO DAN AV-SHUNT CUBITI PADA PASIEN HEMODIALISA DI RSUP PROF KANDOU PERIODE JANUARI 2013 – DESEMBER 2013

e-CliniC ◽  
2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Cliff W. Sulangi
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Research Subjects ◽  
Stage Renal Disease ◽  
End Stage ◽  
Av Shunt ◽  
Success Percentage

Abstract: The procedure of access hemodialysis is a vascular surgical procedure. Vascular access is indicated in patients with end stage renal disease (ESRD) or patients with end stage chronic renal failure and had to take process on hemodialysis. Cimino and AV-Shunt cubiti is two techniques of vascular access operation. This research aims to know the percentage of successful cimino and av-shunt cubiti operation in RSUP Prof Kandou at 2013. This research was conducted using a retrospective descriptive methods. This research subjects were 37 patients. 22 patients with cimino and 15 patient with av-shunt cubiti. The result of this research obtained success percentage use 63,6 % of cimino and the percentage of successful use of av-shunt cubiti is 66,7%. Key words: Vascular access, Ciminom av-shunt cubiti, successful percentage   Abstrak: Prosedur dari akses hemodialisa merupakan prosedur operasi vaskular. Akses vaskular diindikasikan pada pasien dengan end stage renal disease (ERSD) atau pasien dengan gagal ginjal kronik stadium akhir dan harus menjalani proses hemodialisa. Operasi Cimino dan AV-Shunt Cubiti merupakan dua teknik operasi akses vaskular. Penelitian ini bertujuan untuk mengetahui prosentase keberhasilan operasi Cimino dan AV-shunt cubiti pada pasien hemodialisa di RSUP Prof Kandou tahun 2013. Penelitian ini dilakukan menggunakan metode deskriptif retrospektif. Subyek penelitian Berjumlah 37 pasien. 22 pasien operasi Cimino dan 15 pasien dengan AV-Shunt cubiti. Hasil penelitian ini didapatkan Prosentase keberhasilan penggunaan Cimino sebesar 63,6 % dan  prosentase keberhasilan penggunaan AV-Shunt cubiti sebesar 66,7%. Kata Kunci: Akses vaskular, Operasi Cimino, AV-shunt cubiti, prosentase keberhasilan

scholarly journals Provision of Kidney Disease Education Service is Associated with Improved Vascular Access Outcomes among the US Incident Hemodialysis Patients

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004502021
Author(s):  
Rupam Ruchi ◽  
Shahab Bozorgmehri ◽  
Gajapathiraju Chamarthi ◽  
Tatiana Orozco ◽  
Rajesh Mohandas ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
The Us ◽  
Nephrology Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Encompassing Model

Background: Pre-end stage renal disease (ESRD) Kidney Disease Education (KDE) has been shown to improve multiple chronic kidney disease (CKD) outcomes but, its impact on vascular access outcomes is not well-studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods: In this retrospective USRDS analysis, we identified all adult incident hemodialysis patients with a minimum of 6-months of pre-ESRD Medicare coverage during the first five-years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE-cohort) and non-recipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1: KDE alone, model 2: multivariate model encompassing model 1 with socio-demographics, model 3: model 2 with comorbidity and functional status, and model 4: model 3 with pre-ESRD nephrology care). Results: Of the 211,990 qualifying incident hemodialysis patients during the study period, 2,887(1.4%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (29.7% and 34.9% respectively, compared to 14.2% and 17.2%) and pure catheter use about a third lower (40.4% compared to 64.5%) in the KDE cohort compared to the non-KDE cohort. Maximally adjusted odds ratio(99% confidence interval) in model 4 for study outcomes were: incident AVF use: 1.78 (1.55-2.05), incident AVF/AVG use: 1.78 (1.56-2.03), incident CVC with maturing AVF/AVG: 1.69 (1.44-1.97)and pure CVC without any AVF/AVG: 0.51 (0.45-0.58). The benefits of KDE service were maintained even after accounting for the presence, duration and facility of ESRD care. Conclusion: Occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the impact of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

2018 ◽  
Vol 48 (5) ◽  
pp. 330-338 ◽  
Author(s):  
Beini Lyu ◽  
Tanushree Banerjee ◽  
Julia J. Scialla ◽  
Tariq Shafi ◽  
Alexander S. Yevzlin ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Fetuin A ◽  
Av Fistula ◽  
Morphogenetic Protein ◽  
Disease Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Access Complications

Background: Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Method: Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. Results: A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94]) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Conclusion: Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.

scholarly journals Performance and Implementation Evaluation of the Abbott BinaxNOW Rapid Antigen Test in a High-throughput Drive-through Community Testing Site in Massachusetts

2021 ◽  
Author(s):  
Nira R. Pollock ◽  
Jesica R. Jacobs ◽  
Kristine Tran ◽  
Amber Cranston ◽  
Sita Smith ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
High Throughput ◽  
Point Of Care ◽  
High Sensitivity ◽  
High Specificity ◽  
Molecular Testing ◽  
Rt Pcr ◽  
Asymptomatic Children ◽  
Testing Site ◽  
Very High

AbstractBackgroundRapid diagnostic tests (RDTs) for SARS-CoV-2 antigens (Ag) that can be performed at point-of-care (POC) can supplement molecular testing and help mitigate the COVID-19 pandemic. Deployment of an Ag RDT requires an understanding of its operational and performance characteristics under real-world conditions and in relevant subpopulations. We evaluated the Abbott BinaxNOW™ COVID-19 Ag Card in a high-throughput, drive-through, free community testing site in Massachusetts (MA) using anterior nasal (AN) swab RT-PCR for clinical testing.MethodsIndividuals presenting for molecular testing in two of seven lanes were offered the opportunity to also receive BinaxNOW testing. Dual AN swabs were collected from symptomatic and asymptomatic children (≤ 18 years) and adults. BinaxNOW testing was performed in a testing pod with temperature/humidity monitoring. One individual performed testing and official result reporting for each test, but most tests had a second independent reading to assess inter-operator agreement. Positive BinaxNOW results were scored as faint, medium, or strong. Positive BinaxNOW results were reported to patients by phone and they were instructed to isolate pending RT-PCR results. The paired RT-PCR result was the reference for sensitivity and specificity calculations.ResultsOf 2482 participants, 1380 adults and 928 children had paired RT-PCR/BinaxNOW results and complete symptom data. 974/1380 (71%) adults and 829/928 (89%) children were asymptomatic. BinaxNOW had 96.5% (95% confidence interval [CI] 90.0-99.3) sensitivity and 100% (98.6-100.0) specificity in adults within 7 days of symptoms, and 84.6% (65.1-95.6) sensitivity and 100% (94.5-100.0) specificity in children within 7 days of symptoms. Sensitivity and specificity in asymptomatic adults were 70.2% (56.6-81.6) and 99.6% (98.9-99.9), respectively, and in asymptomatic children were 65.4% (55.6-74.4) and 99.0% (98.0-99.6), respectively. By cycle threshold (Ct) value cutoff, sensitivity in all subgroups combined (n=292 RT-PCR-positive individuals) was 99.3% with Ct ≤25, 95.8% with ≤30, and 81.2% with ≤35. Twelve false positive BinaxNOW results (out of 2308 tests) were observed; in all twelve, the test bands were faint but otherwise normal, and were noted by both readers. One invalid BinaxNOW result was identified. Inter-operator agreement (positive versus negative BinaxNOW result) was 100% (n = 2230/2230 double reads). Each operator was able to process 20 RDTs per hour. In a separate set of 30 specimens (from individuals with symptoms ≤7 days) run at temperatures below the manufacturer’s recommended range (46-58.5°F), sensitivity was 66.7% and specificity 95.2%.ConclusionsBinaxNOW had very high specificity in both adults and children and very high sensitivity in newly symptomatic adults. Overall, 95.8% sensitivity was observed with Ct ≤ 30. These data support public health recommendations for use of the BinaxNOW test in adults with symptoms for ≤7 days without RT-PCR confirmation. Excellent inter-operator agreement indicates that an individual can perform and read the BinaxNOW test alone. A skilled laboratorian can perform and read 20 tests per hour. Careful attention to temperature is critical.

scholarly journals Arteriovenous shunt as the best hemodialysis access in Chronic Kidney Disease (CKD) patients: a literature review

2021 ◽  
Vol 1 (1) ◽  
pp. 1-3
Author(s):  
Abed Nego Okthara Sebayang ◽  
Niko Azhari Hidayat
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Access ◽  
Body Part ◽  
Arteriovenous Shunt ◽  
Hemodialysis Access ◽  
Literature Study ◽  
A Minor ◽  
Av Shunt ◽  
Arteries And Veins

Arteriovenous Shunt (AV Shunt) is a minor surgical operation that connects (creating anastomoses) the arteries and veins in the arm or other body part for the purpose of making connection access for hemodialysis. AV shunt is the primary choice in establishing vascular access for hemodialysis in patients with Chronic Kidney Disease (CKD). Therefore, this study aims to review the arteriovenous shunt as a hemodialysis access option in CKD patients. The literature study was conducted by searching various written sources, whether in the form of books, archives, articles and journals, or documents relevant to the problem being studied. The mortality rate after AV shunt is 0%, even though it still has postoperative complications. Based on the location of the operation, making the AV shunt is prioritized on the distal part that is not dominant to minimize the damage to the AV shunt. The location of the wrist, namely the brachiocephalic, is a top priority in making an AV shunt because it has many advantages. AV shunt is the primary choice of vascular access for hemodialysis in patients with chronic kidney disease. It is hoped that through the AV shunt, the life expectancy of patients with CKD can be increased, and patients with CKD must receive support from other disciplines such as interns, psychologists, and the patient's family.

scholarly journals Arterio-Venous (AV) Fistula: Surgical outcome in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan

2013 ◽  
Vol 8 (4) ◽  
pp. 1-6
Author(s):  
S Shah ◽  
N Maharjan ◽  
D Chapagain ◽  
KG Shrestha ◽  
DJ Reddy
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Fistula Formation ◽  
Limiting Factor ◽  
Safe Procedure ◽  
Medical Sciences ◽  
Av Fistula ◽  
Made In

Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) <30ml/min. Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

scholarly journals Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1745
Author(s):  
Krzysztof Nowak ◽  
Mariusz Kusztal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Access ◽  
Electronic Devices ◽  
Systemic Infection ◽  
Venous Hypertension ◽  
Central Vein ◽  
Cardiac Implantable Electronic Devices ◽  
Number Of Patients ◽  
End Stage

Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.

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