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Ghimire A, Shah S, Chauhan U, Ibrahim KS, Jindal K, Kazancioglu R, Luyckx VA, MacRae JM, Olanrewaju TO, Quinn RR, Ravani P, Shah N, Thompson S, Tungsanga S, Vachharanjani T, Arruebo S, Caskey FJ, Damster S, Donner JA, Jha V, Levin A, Malik C, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas. BMC Nephrol 2024; 25:159. [PMID: 38720263 PMCID: PMC11080121 DOI: 10.1186/s12882-024-03593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. METHODS Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. RESULTS Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). CONCLUSIONS High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Samveg Shah
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Utkarsh Chauhan
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kwaifa Salihu Ibrahim
- Nephrology Unit, Department of Medicine, Wuse District Hospital, Abuja, Nigeria
- Department of Internal Medicine, College of Health Sciences, Federal Capital Territory, Nile University, Abuja, Nigeria
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Timothy O Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robert R Quinn
- Departments of Medicine & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tushar Vachharanjani
- Department of Medicine, John D. Dingell Veterans Affairs Medical Center, Wayne State University School of Medicine, Detroit, MI, USA
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Nephrology and Hypertension, University of Cape Town, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, The University of Queensland, Woolloongabba, Queensland, Australia
- Translational Research Institue, University of Queensland, Queensland, Brisbane, Australia
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Darwis P, Limengka Y, Muradi A, Telaumbanua RS, Karina. Endoluminal dilatation technique to remove stuck hemodialysis tunneled catheter: A case report from Indonesia. Int J Surg Case Rep 2021; 79:248-250. [PMID: 33485176 PMCID: PMC7820790 DOI: 10.1016/j.ijscr.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
The phenomenon of the ‘stuck’ catheter in the central vein, where significant traction or additional maneuvers are required to remove the catheter, is not frequently reported in spite of the vast usage of these catheters worldwide. The endoluminal balloon dilatation of the HD catheter not only separates the stuck HD catheter from the adherent vein by breaking the adhesions between them, but also expands the vein simultaneously, thus enabling easy removal of the HD catheter. Endoluminal dilatation technique is a minimally invasive percutaneous technique that appears safe and straightforward and can be performed in any interventional suite while allowing preservation of venous access. Consider endoluminal dilatation technique as a treatment option.
Background Tunneled CVC is being increasingly used worldwide as a mean of vascular access for hemodialysis. Among these, one of the emerging complications is that of the “embedded” or stuck catheter. There have been registered cases of vasomotor collapse, non-ST-elevation myocardial infarction (NSTEMI), avulsion of the vena cava, damage to the tricuspid valve having fatal consequences, and breakage of the CVC (Lodi et al., 2016). Case presentation A 63-year-old female with mature AV fistula came to the clinic for removal of a tunnelled 15 fr double lumen dialysis catheter (Medical Components, Harleysville, Pensylvania) that had been inserted into the left internal jugular vein 15 months prior to this visit. In the OR, our surgical attempt to remove the catheter failed. The first few dilation procedures were performed using 0.035-inch guidewire and balloon catheters. The technique was subsequently modified as follows. In this case we use a 6 × 60 mm Scoreflex balloon. Endoluminal dilation was repeated along the length of the catheter up to the cuff. Once the catheter has been removed, pressure was applied using sterile gauze to aid hemostasis. The procedure was successful without any observed complication. Conclusion Endoluminal dilatation technique is considered as the easiest and safest technique to remove hemodialysis catheter. Our case is the first stuck hemodialysis catheter reported in Indonesia and probably the first case that happen and treat with endoluminal dilatation technique in our country.
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Affiliation(s)
- Patrianef Darwis
- Vascular and Endovascular Division, Surgery Department, Faculty of Medicine University of Indonesia /National General Hospital dr Cipto Mangunkusumo, Jakarta, Indonesia.
| | - Yuliardy Limengka
- Vascular and Endovascular Division, Surgery Department, Faculty of Medicine University of Indonesia /National General Hospital dr Cipto Mangunkusumo, Jakarta, Indonesia
| | - Akhmadu Muradi
- Vascular and Endovascular Division, Surgery Department, Faculty of Medicine University of Indonesia /National General Hospital dr Cipto Mangunkusumo, Jakarta, Indonesia
| | - Rizky Saputra Telaumbanua
- Vascular and Endovascular Division, Surgery Department, Faculty of Medicine University of Indonesia /National General Hospital dr Cipto Mangunkusumo, Jakarta, Indonesia
| | - Karina
- Vascular and Endovascular Division, Surgery Department, Faculty of Medicine University of Indonesia /National General Hospital dr Cipto Mangunkusumo, Jakarta, Indonesia.
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Ryan TJ, Farber A, Cheng TW, Raulli SJ, Sather K, Dicken QG, Levin SR, Zhang Y, Siracuse JJ. Factors associated with a tunneled dialysis catheter in place at initial arteriovenous access creation. J Vasc Surg 2020; 73:1771-1777. [PMID: 33068763 DOI: 10.1016/j.jvs.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Arteriovenous (AV) access is the preferred hemodialysis modality to avoid the complications associated with tunneled dialysis catheters (TDCs). Despite efforts to create timely AV access, many patients still initiate hemodialysis through TDCs. Our goal was to determine the patient factors associated with having a TDC present at initial AV access creation and how this affects survival. METHODS We performed a single-center, retrospective review of all patients who had undergone initial AV fistula creation from 2014 to 2019. Patients with previous peritoneal or AV access were excluded. Univariable and multivariable analyses were used to identify associations with a TDC present at initial AV access creation and patient survival. RESULTS Of 509 patients who had undergone initial AV access creation, a TDC was present in 280 (55%). The mean patient age was 59.7 ± 14.1 years. The access types were brachiocephalic (47.2%), brachiobasilic (22.4%), radiocephalic (15.5%), and prosthetic (12.6%). The patients with a TDC compared with those without a TDC were less likely to be obese (68.9% vs 54.2%), more likely to be homeless (10.4% vs 4.8%), and more likely to be an inpatient (44.6% vs 18.8%). They were less likely to have seen a primary care physician within 1 year preoperatively (54.3% vs 88.6%) and a nephrologist within 3 months preoperatively (39.3% vs 93%; P < .05 for all). On multivariable analysis, the presence of a TDC at initial AV access creation was associated with no nephrology visit within 3 months preoperatively (odds ratio [OR], 25; 95% confidence interval [CI], 12.5-50; P < .001), homeless status (OR, 2.6; 95% CI, 1.1-6.2; P = .03), and the absence of obesity (OR, 1.8; 95% CI, 1.1-2.9; P = .02). The 1-year survival was similar for patients with (95%) and without (94.8%) a TDC (P = .36) as confirmed by multivariable analysis (hazard ratio, 1.2; 95% CI, 0.65-2.1; P = .63). CONCLUSIONS The absence of a preoperative nephrology visit, homeless status, and the absence of obesity were associated with a TDC present at initial AV access creation. However, the presence of a TDC did not appear to confer changes in short-term survival. Targeted improvements in high-risk populations such as increasing the frequency of preoperative subspecialty evaluation might be warranted to reduce TDC placement before AV access creation at urban safety-net hospitals.
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Affiliation(s)
- Tyler J Ryan
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Stephen J Raulli
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Kristiana Sather
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Quinten G Dicken
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Yixin Zhang
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
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Affiliation(s)
- Robert S. Brown
- Nephrology Division Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
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5
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Fila B. Quality indicators of vascular access procedures for hemodialysis. Int Urol Nephrol 2020; 53:497-504. [PMID: 32869172 DOI: 10.1007/s11255-020-02609-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Improved quality of surgical procedures can minimize complications, the morbidity and mortality of patients, and in addition decrease costs. Quality indicators in angioaccess surgery are, however, not clearly defined. The aim of this review article is therefore to find the most important factors affecting quality in vascular access procedures. Even though autogenous arteriovenous fistula has been recognized as the best vascular access for hemodialysis, the high percentage of unsuccessful attempts associated with it raises the question about quality assessment in angioaccess procedures. Unfortunately, quality indicators in vascular access surgery are difficult to define and measure. Among those that can be obtained are: the time between the presentation of patients to a vascular access surgeon and the construction of a fistula, the percentage of autogenous fistulas, the percentage of functional fistulas in prevalent and incident hemodialysis patients, the percentage of creation of a functional fistula in the first attempt, and durability of an access. Organizational improvement and educational programs are also necessary at institutions with inferior quality indicators of vascular access care, as even small increase in quality may mean the survival of an individual patient. Quality indicators in angioaccess surgery can also serve as a helpful tool in choosing the best vascular access surgeon or vascular access center. The choice can consequently reflect on increased survival and quality of life in patients needing hemodialysis.
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Affiliation(s)
- Branko Fila
- Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.
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6
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El Nekidy WS, Soong D, Kadri A, Tabbara O, Ibrahim A, Ghazi IM. Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist. Case Rep Nephrol Dial 2018; 8:121-129. [PMID: 30140677 PMCID: PMC6103365 DOI: 10.1159/000489923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.
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Affiliation(s)
| | - Derrick Soong
- Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Albert Kadri
- Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Osama Tabbara
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amina Ibrahim
- Faculty of Biological Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Islam M. Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
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7
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Dumaine C, Kiaii M, Miller L, Moist L, Oliver MJ, Lok CE, Hiremath S, MacRae JM. Vascular Access Practice Patterns in Canada: A National Survey. Can J Kidney Health Dis 2018; 5:2054358118759675. [PMID: 29511569 PMCID: PMC5833215 DOI: 10.1177/2054358118759675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background: One of the mandates of the Canadian Society of Nephrology’s (CSN) Vascular Access Working Group (VAWG) is to inform the nephrology community of the current status of vascular access (VA) practice within Canada. To better understand VA practice patterns across Canada, the CSN VAWG conducted a national survey. Objectives: (1) To inform on VA practice patterns, including fistula creation and maintenance, within Canada. (2) To determine the degree of consensus among Canadian clinicians regarding patient suitability for fistula creation and to assess barriers to and facilitators of fistula creation in Canada. Design: Development and implementation of a survey. Setting: Community and academic VA programs. Participants: Nephrologists, surgeons, and nurses who are involved in VA programs across Canada. Measurements: Practice patterns regarding access creation and maintenance, including indications and contraindications to fistula creation, as well as program-wide facilitators of and barriers to VA. Methods: A small group of CSN VAWG members determined the scope and created several VA questions which were then reviewed by 5 additional VAWG members (4 nephrologists and 1 VA nurse) to ensure that questions were clear and relevant. The survey was then tested by the remaining members of the VAWG and refinements were made. The final survey version was submitted electronically to relevant clinicians (nephrologists, surgeons, and nurses) involved or interested in VA across Canada. Questions centered around 4 major themes: (1) Practice patterns regarding access creation (preoperative assessment and maturation assessment), (2) Practice patterns regarding access maintenance (surveillance and salvage), (3) Indications and contraindications for arteriovenous (AV) access creation, and (4) Facilitators of and barriers to fistula creation and utilization. Results: Eighty-two percent (84 of 102) of invited participants completed the survey; the majority were nurses or VA coordinators (55%) with the remainder consisting of nephrologists (21%) and surgeons (20%). Variation in practice was noted in utility of preoperative Doppler ultrasound, interventions to assist nonmaturing fistulas, and procedures to salvage failing or thrombosed AV-access. Little consensus was seen regarding potential contraindications to AV-access creation (with the exception of limited life expectancy and poor vasculature on preoperative imaging, which had high agreement). Frequent barriers to fistula utilization were primary failure (77% of respondents) and long maturation times (73%). Respondents from centers with low fistula prevalence also cited long surgical wait times as an important barrier to fistula creation, whereas those from centers with high fistula prevalence cited access to multidisciplinary teams and interventional radiology as keys to successful fistula creation and utilization. Conclusions: There is significant variation in VA practice across Canada and little consensus among Canadian clinicians regarding contraindications to fistula creation. Further high-quality studies are needed with regard to appropriate fistula placement to help guide clinical practice.
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Affiliation(s)
- Chance Dumaine
- Division of Nephrology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Lisa Miller
- Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Louise Moist
- Division of Nephrology, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Charmaine E Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Department of Medicine, University of Calgary, Alberta, Canada
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Talreja H, Ryan SE, Graham J, Sood MM, Hadziomerovic A, Clark E, Hiremath S. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes. PLoS One 2017; 12:e0174061. [PMID: 28346468 PMCID: PMC5367692 DOI: 10.1371/journal.pone.0174061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES 1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.
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Affiliation(s)
- Hari Talreja
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Edward Ryan
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet Graham
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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9
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Clark EG, Akbari A, Hiebert B, Hiremath S, Komenda P, Lok CE, Moist LM, Schachter ME, Tangri N, Sood MM. Geographic and facility variation in initial use of non-tunneled catheters for incident maintenance hemodialysis patients. BMC Nephrol 2016; 17:20. [PMID: 26920700 PMCID: PMC4769546 DOI: 10.1186/s12882-016-0236-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/19/2016] [Indexed: 11/20/2022] Open
Abstract
Background Non-tunneled (temporary) hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with NTHC use in this context. We sought to determine factors associated with NTHC use and examine regional and facility-level variation in NTHC use for incident maintenance hemodialysis patients. Methods We analyzed registry data collected between January 2001 and December 2010 from 61 dialysis facilities within 12 geographic regions in Canada. Multi-level models and intra-class correlation coefficients were used to evaluate variation in NTHC use as initial hemodialysis access across facilities and geographic regions. Facility and patient characteristics associated with the lowest and highest quartiles of NTHC use were compared. Results During the study period, 21,052 patients initiated maintenance hemodialysis using a central venous catheter (CVC). This included 10,183 patients (48.3 %) in whom the initial CVC was a NTHC, as opposed to a tunneled CVC. Crude variation in NTHC use across facilities ranged from 3.7 to 99.4 % and across geographic regions from 32.4 to 85.1 %. In an adjusted multi-level logistic regression model, the proportion of total variation in NTHC use explained by facility-level and regional variation was 40.0 % and 34.1 %, respectively. Similar results were observed for the subgroup of patients who received greater than 12 months of pre-dialysis nephrology care. Patient-level factors associated with increased NTHC use were male gender, history of angina, pulmonary edema, COPD, hypertension, increasing distance from dialysis facility, higher serum phosphate, lower serum albumin and later calendar year. Conclusions There is wide variation in NTHC use as initial vascular access for incident maintenance hemodialysis patients across facilities and geographic regions in Canada. Identifying modifiable factors that explain this variation could facilitate a reduction of NTHC use in favor of more optimal initial vascular access.
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Affiliation(s)
- Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. .,The Ottawa Hospital - Riverside Campus, 1967 Riverside Drive, Ottawa, ON, K1H 7 W9, Canada.
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Brett Hiebert
- Cardiac Sciences Program, St Boniface Hospital, Winnipeg, MB, Canada.
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Paul Komenda
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Charmaine E Lok
- Division of Nephrology, Department of Medicine, Toronto General Hospital and University of Toronto, Toronto, ON, Canada.
| | - Louise M Moist
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University and Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.
| | | | | | - Manish M Sood
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
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10
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Chen YM, Wang YC, Hwang SJ, Lin SH, Wu KD. Patterns of Dialysis Initiation Affect Outcomes of Incident Hemodialysis Patients. Nephron Clin Pract 2015; 132:33-42. [PMID: 26588170 DOI: 10.1159/000442168] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS There is a trend toward deferring the initiation of chronic dialysis until absolutely indicated. This strategy, however, might lead to increased uncertainties in the timing of dialysis access creation prior to dialysis onset for patients approaching end-stage renal disease (ESRD), and the impact of which on hard end points remains largely unclear. We hereby investigated the effect of varied patterns of dialysis initiation on outcomes of new-onset hemodialysis (HD) patients. METHODS Four hundred sixty-two prospectively recruited patients were stratified into planned elective (n = 117, 25%), planned urgent (n = 65, 14%) or unplanned urgent (n = 280, 61%) starters based on the timing of access creation with respect to dialysis initiation. The outcome measures were all-cause mortality, hospitalization and access reconstruction over 2 years. RESULTS The mean estimated glomerular filtration rate (eGFR) was higher in the planned elective than in the planned urgent or unplanned urgent starters at access creation (5.3 vs. 4.4 or 4.3 ml/min/1.73 m2), but not at dialysis initiation (4.2 vs. 3.9 or 4.3 ml/min/1.73 m2). During the follow-up, the planned elective population exhibited the lowest rates of overall mortality and hospitalization, but not access reconstruction. Multivariate Cox's regression analysis showed that the planned urgent and the unplanned urgent groups, comparing to the planned elective population, displayed a greater risk of early death (hazards ratio [HR] 3.324, 95% CI 1.409-7.840; HR 2.510, 95% CI 1.177-5.355, respectively) and early hospitalization (sub-hazards ratio [SubHR] 2.238, 95% CI 1.530-3.274; SubHR 1.529, 95% CI 1.096-2.133, respectively). CONCLUSION Incident ESRD patients undergoing planned elective start of HD, compared to their planned or unplanned urgent counterparts, showed reduced risk of overall mortality and hospitalization in the first 2 years after commencing long-term dialysis at a mean eGFR <5 ml/min/1.73 m2.
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Affiliation(s)
- Yung-Ming Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taipei, Taiwan
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Zhang JC, Al-Jaishi A, Perl J, Garg AX, Moist LM. Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure. Am J Kidney Dis 2015; 66:646-54. [DOI: 10.1053/j.ajkd.2015.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/11/2015] [Indexed: 12/31/2022]
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Effect of a Rapid Clinical Protocol to the Conversion from Central Venous Hemodialysis Catheter to Arteriovenous Access. J Vasc Access 2015; 17:124-30. [DOI: 10.5301/jva.5000489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Evaluation of the rapid conversion protocol that includes an ambulatory dialysis access center (DAC), and a three-step clinical pathway, to the conversion rate from central venous hemodialysis (HD) catheter to functioning arteriovenous (AV) access. Methods Prospective data were collected on 97 consecutive catheter-dependent HD patients. DAC is defined as an ambulatory unit, able to accommodate clinic visits, ultrasound examinations, surgical, interventional and hybrid procedures. Step I: initial evaluation, vein mapping and creation of AV access. Step II: clinical evaluation in two weeks and if failure identified, secondary procedure to restore function. Step III: evaluation in four weeks after creation, and additional procedure to promote maturation if indicated. The success rate, time to conversion and time to catheter removal were recorded. Results From the 97 consecutive referred patients, eight patients were excluded. From the remaining 89 patients, 99% were successfully converted to AV access. Seventy-three percent of the patients were converted to native arteriovenous fistulae and 27% of the patients to prosthetic arteriovenous shunts. The median time from creation to HD catheter removal was 63 (SD 41) days. Fifty-two percent of the patients required at least one additional secondary procedure to accomplish successful conversion Conclusions High rates of timely conversion from catheter to AV access, primarily AV fistulae, can be accomplished within the context of the rapid conversion protocol.
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Vascular access for incident hemodialysis patients in Catalonia: analysis of data from the Catalan Renal Registry (2000-2011). J Vasc Access 2015; 16:472-9. [DOI: 10.5301/jva.5000410] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Arteriovenous fístula is the best vascular access (VA) for hemodialysis. We analyzed the VA used at first session and the factors associated with the likelihood to start hemodialysis by fistula in 2000-2011. Methods Data of VA type were obtained in 9,956 incident hemodialysis patients from the Catalan Registry. Results Overall, 47.9% of patients initiated hemodialysis with a fistula, 1.2% with a graft, 15.9% with a tunneled catheter and 35% with an untunneled catheter. The percentage of incident patients with fistula and catheter has remained stable at around 50% over the years. The likelihood to start hemodialysis with fistula was significantly lower in females [adjusted odds ratio: 0.69, 95% confidence interval (CI): 0.61-0.75], patients aged 18-44 years (0.78, 95% CI: 0.64-0.94), patients with comorbidity (0.67, 95% CI: 0.60-0.75) and tended to be lower in patients aged over 74 years (0.89, 95% CI: 0.78-1.01). The probability to use fistula was significantly higher in patients with polycystic kidney disease (2.08, 95% CI: 1.63-2.67), predialysis nephrology care longer than 2 years (4.14, 95% CI: 3.63-4.73) and steady chronic kidney disease (CKD) progression (10.97, 95% CI: 8.41-14.32). During 1 year of follow-up, 67.2% and 59.6% of patients using untunneled and tunneled catheter changed to fistula, respectively. Conclusions Starting hemodialysis by fistula was related with nonmodifiable patient characteristics and modifiable CKD practice processes, such as predialysis care duration. Half of the incident patients were exposed annually in Catalonia to potential catheter complications. This scenario can be improved by optimizing the processes of CKD care.
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Brown PA, Akbari A, Molnar AO, Taran S, Bissonnette J, Sood M, Hiremath S. Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study. PLoS One 2015; 10:e0130080. [PMID: 26047510 PMCID: PMC4457723 DOI: 10.1371/journal.pone.0130080] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/15/2015] [Indexed: 11/18/2022] Open
Abstract
The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital) is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD) clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital) or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4%) initiated dialysis, of which 76 patients (41.3%) initiated dialysis in an unplanned fashion and 108 (58.7%) starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04), CAD (42.1% versus 24.1%; p = 0.02), congestive heart failure (36.8% versus 17.6%; p = 0.01), and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01) or be assessed by a surgeon for access creation (40.8% vesrus78.7% p < 0.01). On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13), and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41) were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.
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Affiliation(s)
- Pierre Antoine Brown
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amber O Molnar
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Janice Bissonnette
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manish Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Leou S, Garnier F, Testevuide P, Lumbroso C, Rigault S, Cordonnier C, Hanf W. [Infectious complications rate from hemodialysis catheters: experience from the French Polynesia]. Nephrol Ther 2013; 9:137-42. [PMID: 23434289 DOI: 10.1016/j.nephro.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 11/16/2022]
Abstract
The arterio-venous fistula (AVF) is the most common vascular access to perform hemodialysis (HD). The HD venous central catheter use should only be proposed to old patients and/or patients without vascular access construction feasibility. These HD catheters are often responsible of infectious and thrombosis complications. We performed, for the first time in French Polynesia, a retrospective study based on 214 patients receiving 618 HD catheters, to evaluate the infectious complication rate due to HD catheters. We showed that 17.4% of HD catheters present with infection. The number of bacteraemia due to HD catheters is 2.57/1000 days-catheters and the number of infection due to HD catheter is 1.43/1000 days-catheters. Eighteen percent of patients requiring an emergency HD without AVF access are transferred in intensive care unit due to infectious HD catheter complications. We observed a similar bacteriological environment than in literature. However, the number of tunneled HD catheter is really lower to that of the number required in European recommendations and we observed an abnormal number of non-functional AVF 1 month after creation. These results involve our nephrology unit to increase the number of tunneled catheters to limit the infectious risk and also to fit with the best practices guidelines.
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Affiliation(s)
- Sylvie Leou
- Service de Néphrologie, Centre Hospitalier Territorial de Polynésie Française, Centre Hospitalier de Polynésie Française, BP 1640, 98713 Papeete, Polynésie Française
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Hiremath S, Knoll G, Weinstein MC. Should the arteriovenous fistula be created before starting dialysis?: a decision analytic approach. PLoS One 2011; 6:e28453. [PMID: 22163305 PMCID: PMC3233576 DOI: 10.1371/journal.pone.0028453] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/08/2011] [Indexed: 11/18/2022] Open
Abstract
Background An arteriovenous fistula (AVF) is considered the vascular access of choice, but uncertainty exists about the optimal time for its creation in pre-dialysis patients. The aim of this study was to determine the optimal vascular access referral strategy for stage 4 (glomerular filtration rate <30 ml/min/1.73 m2) chronic kidney disease patients using a decision analytic framework. Methods A Markov model was created to compare two strategies: refer all stage 4 chronic kidney disease patients for an AVF versus wait until the patient starts dialysis. Data from published observational studies were used to estimate the probabilities used in the model. A Markov cohort analysis was used to determine the optimal strategy with life expectancy and quality adjusted life expectancy as the outcomes. Sensitivity analyses, including a probabilistic sensitivity analysis, were performed using Monte Carlo simulation. Results The wait strategy results in a higher life expectancy (66.6 versus 65.9 months) and quality adjusted life expectancy (38.9 versus 38.5 quality adjusted life months) than immediate AVF creation. It was robust across all the parameters except at higher rates of progression and lower rates of ischemic steal syndrome. Conclusions Early creation of an AVF, as recommended by most guidelines, may not be the preferred strategy in all pre-dialysis patients. Further research on cost implications and patient preferences for treatment options needs to be done before recommending early AVF creation.
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Affiliation(s)
- Swapnil Hiremath
- Division of Nephrology, Kidney Research Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Gallieni M, Saxena R, Davidson I. Dialysis access in europe and north america: are we on the same path? Semin Intervent Radiol 2011; 26:96-105. [PMID: 21326499 DOI: 10.1055/s-0029-1222452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Large differences in dialysis access exist between Europe, Canada, and the United States, even after adjustment for patient characteristics. Vascular access care is characterized by similar issues, but with a different magnitude. Obesity, type 2 diabetes, and peripheral vascular disease, independent predictors of central venous catheter use, are growing problems globally, which could lead to more difficulties in native arteriovenous fistula placement and survival. Creation of dedicated dialysis access teams, including a vascular access coordinator, is a fundamental step in improving vascular access care; however, it might not be sufficient. The possibility that factors other than patient characteristics and surgical skills are important in determining outcomes is likely; it might explain apparent contradictions of end-stage renal disease (ESRD) practices (kidney transplant, peritoneal dialysis, patterns of vascular access use in hemodialysis), where some countries excel in one area and score poorly in another. We are on the same path, but we have a long way to go.
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Power A, Singh SK, Ashby D, Cairns T, Taube D, Duncan N. Long-term Tesio catheter access for hemodialysis can deliver high dialysis adequacy with low complication rates. J Vasc Interv Radiol 2011; 22:631-7. [PMID: 21419650 DOI: 10.1016/j.jvir.2010.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/07/2010] [Accepted: 12/29/2010] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The use of central venous catheters for long-term hemodialysis has been associated with increased mortality and high prevalence of infection and venous stenosis. However, because central venous catheters still constitute a significant proportion of vascular access in prevalent populations, even in the Fistula-First era, the authors examined the long-term patient outcomes and performance of this vascular access type to inform current clinical practice. MATERIALS AND METHODS The authors conducted a retrospective cohort study of 433 patients on maintenance hemodialysis in a dialysis program from January 1999 through April 2008 all using twin-catheter Tesio Caths (TCs) (MedCOMP, Harleysville, Pennsylvania). Written and electronic records were examined with respect to laboratory indices as well as mortality, access-related infection, need for thrombolytic infusion, access revision and dialysis adequacy. RESULTS A total of 759 TCs were inserted with 552,035 catheter days follow-up. Thirty-six percent of insertions were in patients incident to dialysis (< 90 days). Mean single-pool Kt/V was 1.6 ± 0.3. Cumulative cohort survival rates were 85%, 72%, and 48% at 1, 2, and 5 years, respectively. No patients died as a result of lack of vascular access. Cumulative assisted primary access site patencies were 76%, 62%, and 42% at 1, 2, and 5 years, respectively. The prevalence of symptomatic central venous stenosis was 5%. Catheter-related bacteremia occurred at a rate of 0.34 per 1,000 catheter days. CONCLUSIONS Appropriate use of TCs with protocolized care can deliver effective long-term hemodialysis with good adequacy and rates of access-related infection approaching those seen with arteriovenous grafts.
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Affiliation(s)
- Albert Power
- Haemodialysis Research Group, Imperial College Kidney and Transplant Institute, West London Renal & Transplant Centre, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom.
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Hiremath S, Doucette SP, Richardson R, Chan K, Burns K, Zimmerman D. Left ventricular growth after 1 year of haemodialysis does not correlate with arteriovenous access flow: a prospective cohort study. Nephrol Dial Transplant 2010; 25:2656-61. [PMID: 20185857 DOI: 10.1093/ndt/gfq081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The incidence of congestive heart failure is 3-fold greater than that of acute coronary syndrome in haemodialysis (HD) patients. The purpose of this study was to determine if blood flow through an arteriovenous (AV) access contributes to an increase in left ventricular mass (LVM) that may increase the risk of congestive heart failure. METHODS We conducted a 1-year prospective cohort study at two Canadian centres of HD patients at high risk for congestive heart failure who had a first AV access created. Patients underwent echocardiography and measurement of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels before and 1-year post-AV access creation. Access flows were measured within the first month of access maturation and 1-year post-access creation. Data were analysed using descriptive statistics, Student's t-test, correlation coefficients and regression. RESULTS One-year post-AV access creation, LVM increased by 12.2 +/- 32% (P = 0.025) and plasma NT-proBNP levels increased by 170 +/- 465% (P = 0.02). The average AV access blood flow did not correlate with an increase in LVM or NT-proBNP levels. CONCLUSIONS In patients on chronic HD after 1 year, AV access flow does not correlate with increases in LVM by echocardiography or plasma levels of NT-proBNP.
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Affiliation(s)
- Swapnil Hiremath
- Division of Nephrology, Kidney Research Centre, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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Power A, Singh S, Ashby D, Hamady M, Moser S, Gedroyc W, Taube D, Duncan N, Cairns T. Translumbar central venous catheters for long-term haemodialysis. Nephrol Dial Transplant 2009; 25:1588-95. [PMID: 20023114 DOI: 10.1093/ndt/gfp683] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients in the UK, Canada and the USA. Use of CVCs is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. Lack of conventional venous access routes mandates the use of alternative strategies such as the translumbar approach. METHODS We retrospectively analysed patients at our centre requiring translumbar inferior vena caval CVCs (TesioCath) for haemodialysis in the period 1999-2008. Written and electronic records capturing dialysis adequacy and complications, hospital admissions and laboratory data were examined. RESULTS Thirty-nine pairs of translumbar CVCs were inserted in 26 patients with 15 864 catheter days follow-up, mean patient age 61.9 +/- 12.1 years, 31% diabetic, 15% with ischaemic heart disease. All insertions were successful. Insertion of one CVC was associated with a self-limiting retroperitoneal haematoma. No patients died of a catheter-related cause or through lack of vascular access. Cumulative assisted primary catheter site patency was 81% at 6 months and 73% at 1 year (median 18.5 months). Good dialysis adequacy was achieved throughout (mean single-pool Kt/V 1.5 +/- 0.4). The incidence of access-related infection was 2.84/1000 catheter days (exit site infection rate 2.02/1000 catheter days; catheter-related bacteraemia rate 0.82/1000 catheter days). Catheter dysfunction (need for thrombolytic infusion or catheter change) led to 0.88 admissions per 1000 catheter days. CONCLUSION Translumbar inferior vena caval CVCs can offer relatively safe and effective long-term haemodialysis access in patients with no other options.
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Affiliation(s)
- Albert Power
- Imperial College Kidney and Transplant Institute, West London Renal and Transplant Centre, Imperial College Healthcare Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.
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Ashby DR, Power A, Singh S, Choi P, Taube DH, Duncan ND, Cairns TD. Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage. Clin J Am Soc Nephrol 2009; 4:1601-5. [PMID: 19679668 DOI: 10.2215/cjn.01840309] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a prospective cohort study, all cases of catheter-associated bacteremia that occurred in a large dialysis center were identified during a 12-mo period. Catheter salvage was attempted according to a standard protocol in all cases in which a favorable early response to antibiotic therapy was seen, and patients were followed for at least 6 mo. Bacteremias, catheter changes, and all major clinical events were recorded. RESULTS During a period covering 252,986 catheter days, 208 episodes were identified involving 133 patients, 74% of which were selected for attempted salvage. Salvage was successful in 66.1% of incident bacteremias with a very low complication risk (0.9%). Some bacteremias, however, recurred as late as 6 mo after the initial infection; salvage was less likely to be successful in treating recurrences. CONCLUSIONS Appropriately used catheter salvage can be successful in approximately two thirds of cases; however, recurrences continue to occur up to 6 mo later and are unlikely to be cured without catheter replacement.
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Affiliation(s)
- Damien R Ashby
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, United Kingdom.
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Jean G, Vanel T, Bresson É, Terrat JC, Hurot JM, Lorriaux C, Mayor B, Chazot C. Une stratégie efficace pour diminuer l’utilisation et les complications des cathéters veineux centraux tunnelisés en hémodialyse. Nephrol Ther 2009; 5:280-6. [DOI: 10.1016/j.nephro.2009.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
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