Telemedicine using Skype video calls for vascular access problems in dialysis patients

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients constitution, and also on the availability and experience of the involved specialists.

Download Full-text

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

Education thérapeutique du patient - Therapeutic patient education ◽

10.1051/tpe/2018015 ◽

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.

Download Full-text

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Download Full-text

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

The Journal of Vascular Access ◽

10.1177/1129729818762982 ◽

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.

Download Full-text

Vascular Access versus the Effect of Statins on Inflammation and Fibrinolysis in Renal Dialysis Patients

The Journal of Vascular Access ◽

10.5301/jva.5000132 ◽

2013 ◽

Vol 14 (4) ◽

pp. 335-341 ◽

Cited By ~ 3

Author(s):

Maria do Sameiro Faria ◽

Sandra Ribeiro ◽

Petronila Rocha-Pereira ◽

Vasco Miranda ◽

Alexandre Quintanilha ◽

...

Keyword(s):

Vascular Access ◽

Renal Dialysis ◽

Dialysis Patients

Download Full-text

Preservation of vascular access.

Journal of the American Society of Nephrology ◽

10.1681/asn.v44997 ◽

1993 ◽

Vol 4 (4) ◽

pp. 997-1003

Author(s):

J L Porile ◽

M Richter

Keyword(s):

Vascular Access ◽

Venous Pressure ◽

Graft Loss ◽

Laboratory Evaluation ◽

Dialysis Access ◽

New Techniques ◽

Lower Complication ◽

Lower Complication Rate ◽

Access Problems

Preservation of vascular access is critical in the long-term successful management of hemodialysis patients. Dialysis access abnormalities are the most common cause of hospitalization in this patient group, and access problems can increase the morbidity and cost involved in the care of these patients. Native fistulas are preferable to synthetic grafts because of longer survival and a lower complication rate. Venous outflow stenosis is the most common site of obstruction in a failing graft. The pathophysiology of access failure is poorly understood, but it seems to be related to intimal hyperplasia in the native vessel downstream from the anastomosis. The stimulation of local growth factors by needle puncture may also play a role. An assessment of access adequacy includes careful physical examination, laboratory evaluation, and ultimately, angiography. Measurements of recirculation and venous pressure are commonly used to screen for access dysfunction, and their appropriate use will lower the incidence of graft loss in dialysis units. Treatment is usually either angioplasty or surgery, with some centers having success with thrombolytic therapy. New techniques such as atherectomy and stent placement may prove to be beneficial, but this requires further study.

Download Full-text

Tailoring the initial vascular access for dialysis patients

Kidney International ◽

10.1046/j.1523-1755.2002.00436.x ◽

2002 ◽

Vol 62 (1) ◽

pp. 329-338 ◽

Cited By ~ 138

Author(s):

Klaus Konner ◽

Tempie E. Hulbert-Shearon ◽

Erik C. Roys ◽

Friedrich K. Port

Keyword(s):

Vascular Access ◽

Dialysis Patients

Download Full-text

Sex differences in the vascular access of hemodialysis patients: a cohort study

Clinical Kidney Journal ◽

10.1093/ckj/sfaa132 ◽

2020 ◽

Author(s):

Jennifer M MacRae ◽

Alix Clarke ◽

Sofia B Ahmed ◽

Meghan Elliott ◽

Rob R Quinn ◽

...

Keyword(s):

Vascular Access ◽

Reporting System ◽

Incidence Rate Ratio ◽

Binary Logistic Regression ◽

Peripheral Vascular ◽

Dialysis Patients ◽

Measurement Analysis ◽

Artery Disease ◽

To Receive ◽

Access Data

Abstract Background We describe differences for probability of receiving a fistula attempt, achieving fistula use, remaining catheter-free and the rate of access-related procedures as a function of sex. Methods Prospectively collected vascular access data on incident dialysis patients from five Canadian programs using the Dialysis Measurement Analysis and Reporting System to determine differences in fistula-related outcomes between women and men. The probability of receiving a fistula attempt and the probability of fistula use were determined using binary logistic regression. Catheter and fistula procedure rates were described using Poisson regression. We studied time to fistula attempt and time to fistula use, accounting for competing risks. Results We included 1446 (61%) men and 929 (39%) women. Men had a lower body mass index (P < 0.001) and were more likely to have coronary artery disease (P < 0.001) and peripheral vascular disease (p < 0.001). A total of 688 (48%) men and 403 (43%) women received a fistula attempt. Women were less likely to receive a fistula attempt by 6 months {odds ratio [OR] 0.64 [95% confidence interval (CI) 0.52–0.79]} and to achieve catheter-free use of their fistula by 1 year [OR 0.38 (95% CI 0.27–0.53)]. At an average of 2.30 access procedures per person-year, there is no difference between women and men [incidence rate ratio (IRR) 0.97 (95% CI 0.87–1.07)]. Restricting to those with a fistula attempt, women received more procedures [IRR 1.16 (95% CI 1.04–1.30)] attributed to increased catheter procedures [IRR 1.50 (95% CI 1.27–1.78)]. There was no difference in fistula procedures [IRR women versus men 0.96 (95% CI 0.85–1.07)]. Conclusion Compared with men, fewer women undergo a fistula attempt. This disparity increases after adjusting for comorbidities. Women have the same number of fistula procedures as men but are less likely to successfully use their fistula.

Download Full-text