Archive for the ‘Vascular Access’ Category

May 1, 2017

The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death

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This study was designed to determine the proportion of access-related deaths in a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. There was significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt […]

No Comments Posted in Chronic Kidney Disease, Hemodialysis, Vascular Access
February 9, 2017

Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development

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Arteriovenous fistula (AVF) maturation failure is the primary cause of dialysis vascular access dysfunction. To evaluate whether preoperative vascular functional properties predict postoperative AVF measurements, patients enrolled in the Hemodialysis Fistula Maturation Study underwent up to five preoperative vascular function tests (VFTs): flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), carotid-femoral pulse wave velocity, carotid-radial pulse wave […]

No Comments Posted in Clinical Nephrology, Hemodialysis, Vascular Access
February 9, 2017

The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death

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This is a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. The authors observed significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt in patients aged <65 years and in the first […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Hemodialysis, Vascular Access
May 29, 2016

Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials

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This phase 2 trial looked at bioengineered human acellular vessel as an option for dialysis access in 60 patients that were not candidates for arteriovenous fistulas.  The results show that onne vessel became infected during 82 patient-years of follow-up. There were no vessels with dilatation and there was rarely any post-cannulation bleeding. At 12 months, […]

No Comments Posted in Hemodialysis, Vascular Access
March 23, 2016

Vascular Access Type and Patient and Technique Survival in Home Hemodialysis Patients: The Canadian Organ Replacement Register.

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This registry-based retrospective observational cohort study assessed 1217 incident HHD patients in The Canadian Organ Replacement Register who had information for vascular access type (CVC vs AV access) within the first year of HHD therapy initiation.  The results showed that AV access use (n=694) was associated with lower risk for the composite event of death and technique failure (490 events; adjusted HR, 0.78; 95% CI, 0.64-0.94) and lower adjusted all-cause […]

No Comments Posted in Chronic Kidney Disease, Clinical Trial Results, Vascular Access
May 8, 2015

Outcomes of Elderly Patients after Predialysis Vascular Access Creation

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A cohort of 3418 CKD patients ≥70 years who underwent predialysis AVF or AVG creation from 2004 to 2009 were assessed and followed.  The results show that 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race. Only one half of patients initiated […]

No Comments Posted in Clinical Nephrology, Hemodialysis, Vascular Access
December 21, 2013

Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

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This meta-analysis suggests that an antimicrobial-containing citrate lock is better than heparin lock for prevention of catheter-related infection, while citrate alone fails to show a similar advantage. As compared to heparin, citrate locking showed a reduction in bleeding episodes.

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September 18, 2012

A Randomized Trial Comparing Buttonhole with Rope Ladder Needling in Conventional Hemodialysis Patients.

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This randomized controlled trial comparing button hole versus standard AV fistula needling showed an increased risk of bacteremia and localized infection with buttonhole needling.

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May 23, 2012

Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial.

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This North American multicentre study enrolled 201 patients with Stage V CKD. On day 7 after graft creation, participants were randomly allocated to receive fish oil capsules (four 1-g capsules/d) or matching placebo. Daily fish oil ingestion did not decrease the proportion of grafts with loss of patency at 12 months though it did show […]

1 Comment Posted in Hemodialysis, Vascular Access
April 5, 2012

Likelihood of Starting Dialysis after Incident Fistula Creation

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This analysis of administrative data estimated the risk of fistula non-use in predialysis patients with a fistula.  Eighty-one percent of patients initiated dialysis; 9% of patients died without receiving dialysis, and 10% of patients remained predialysis. These results suggest that a fistula is used in the majority of patients in whom it is created.

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November 12, 2011

Late Breaking Clinical Trials at ASN 2011 – FISH study and more

The late breaking clinical trials session from the 2011 American Society of Nephrology meeting was held on November 12, 2011.  The following are summaries of some of the clinical trial results.  Access to the full details of these studies awaits publication in peer reviewed journals. Charmaine E. Lok et al.  The Fish Oil Inhibition of Stenosis […]

Comments Off on Late Breaking Clinical Trials at ASN 2011 – FISH study and more Posted in Bone Mineral Metabolism, Clinical Trial Results, General Nephrology, Glomerulonephritis, Pediatric Nephrology, Renal Transplantation, Vascular Access
June 15, 2011

Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival

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The question of early survival benefit in peritoneal dialysis is addressed in this study of CORR incident adult dialysis patients.  By comparing the survival of incident PD patients with those who initiated HD with a central venous cathter or with a functional arteriovenous fistula or graft, it was determined that the use of CVCs in […]

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April 24, 2011

Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections

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Given the large number of central venous catheters placed by Nephrologists, this clinical practice guideline reviews preventative strategies to reduce infections.   Areas of focus include a) educating and training healthcare personnel who insert and maintain catheters; b) using maximal sterile barrier precautions during central venous catheter insertion; c) using a > 0.5% chlorhexidine skin preparation […]

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