scholarly journals Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Delin Wang ◽  
Nathan Calabro-Kailukaitis ◽  
Mahmoud Mowafy ◽  
Eric S Kerns ◽  
Khetisuda Suvarnasuddhi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Cohort ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Central Venous ◽  
The Usa ◽  
The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average >1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P < 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S41-S46 ◽  
Author(s):  
Maurizio Gallieni ◽  
Antonino Giordano ◽  
Anna Ricchiuto ◽  
Davide Gobatti ◽  
Maurizio Cariati
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Dialysis Access ◽  
Central Venous ◽  
Treatment Start ◽  
Alternative Approach ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

scholarly journals Hyperlipidemia and mortality associated with diabetes mellitus co-existence in Chinese peritoneal dialysis patients

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Xin Wei ◽  
Yueqiang Wen ◽  
Qian Zhou ◽  
Xiaoran Feng ◽  
Fen Fen Peng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Dialysis Patients ◽  
Term Survival ◽  
Risk Of Mortality ◽  
Subgroup Analyses ◽  
All Cause Mortality

Abstract Background To evaluate associations between diabetes mellitus (DM) coexisting with hyperlipidemia and mortality in peritoneal dialysis (PD) patients. Methods This was a retrospective cohort study with 2939 incident PD patients in China from January 2005 to December 2018. Associations between the DM coexisting with hyperlipidemia and mortality were evaluated using the Cox regression. Results Of 2939 patients, with a median age of 50.0 years, 519 (17.7%) died during the median of 35.1 months. DM coexisting with hyperlipidemia, DM, and hyperlipidemia were associated with 1.93 (95% CI 1.45 to 2.56), 1.86 (95% CI 1.49 to 2.32), and 0.90 (95% CI 0.66 to 1.24)-time higher risk of all-cause mortality, compared with without DM and hyperlipidemia, respectively (P for trend < 0.001). Subgroup analyses showed a similar pattern. Among DM patients, hyperlipidemia was as a high risk of mortality as non-hyperlipidemia (hazard ratio 1.02, 95%CI 0.73 to 1.43) during the overall follow-up period, but from 48-month follow-up onwards, hyperlipidemia patients had 3.60 (95%CI 1.62 to 8.01)-fold higher risk of all-cause mortality than those non-hyperlipidemia (P interaction = 1.000). Conclusions PD patients with DM coexisting with hyperlipidemia were at the highest risk of all-cause mortality, followed by DM patients and hyperlipidemia patients, and hyperlipidemia may have an adverse effect on long-term survival in DM patients.

scholarly journals Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

2018 ◽  
Vol 47 (3) ◽  
pp. 153-161 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Vidhya Parameswaran ◽  
Linda H. Ficociello ◽  
Ludmila Anderson ◽  
Norma J. Ofsthun ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Routine Care ◽  
Serum Phosphorus ◽  
Pill Burden ◽  
Dialysis Patients ◽  
Database Analysis ◽  
Baseline Serum ◽  
The Mean ◽  
Phosphorus Levels

Background: A database analysis was conducted to assess the effectiveness of sucroferric oxyhydroxide (SO) on lowering serum phosphorus and phosphate binder (PB) pill burden among adult peritoneal dialysis (PD) patients prescribed SO as part of routine care. Methods: Adult PD patients (n = 258) prescribed SO through a renal pharmacy service were analyzed. Baseline was 3 months before SO prescription. SO-treated follow-up was for 6 months or until either a new PB was prescribed, SO was not refilled, PD modality changed, or patient was discharged. In-range serum phosphorus was defined as ≤5.5 mg/dL. Results: At baseline, mean serum phosphorus was 6.59 mg/dL with 10 prescribed PB pills/day. The proportion of patients achieving in-range serum phosphorus increased by 72% from baseline to month 6. Prescribed PB pills/day decreased by 57% (10 at baseline to 4.3 at SO follow-up, p < 0.0001). The mean length of SO follow-up was 5.1 months; SO follow-up ended for 38, 27, and 50 patients at months 4, 5, and 6, respectively, due to no further PB fills, and for 10, 11, and 4 patients at months 4, 5, and 6, respectively, due to another PB prescribed. In patients with baseline serum phosphorus >5.5 mg/dL who achieved in-range serum phosphorus during SO follow-up for ≥1 quarter, a notable improvement in serum phosphorus (6.54 to 5.10 mg/dL, p < 0.0001) was observed, and there was a 53% reduction in PB pill burden (9.9 to 4.7, p < 0.0001). Conclusion: Among PD patients prescribed SO as part of routine care, improvements in serum phosphorus control and >50% reduction in PB pills/day were observed.

Shortage of Appendicular Skeletal Muscle is an Independent Risk Factor for Mortality in Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Sanli Jin ◽  
Qian Lu ◽  
Chunyan Su ◽  
Dong Pang ◽  
Tao Wang
Keyword(s):  
Skeletal Muscle ◽  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Energy Intake ◽  
Independent Risk Factor ◽  
Proportional Hazards Model ◽  
Dialysis Patients ◽  
Appendicular Skeletal Muscle ◽  
The Mean

BackgroundLimited data are available on clinical outcomes among peritoneal dialysis patients with shortage of appendicular skeletal muscle (ASM). In this study, we tested the hypothesis that the shortage of ASM is an independent risk factor for mortality in continuous ambulatory peritoneal dialysis (CAPD) patients.MethodsAdult patients undergoing CAPD between March and August 2007 in a single center in China were recruited in this prospective cohort study. Body composition, protein/energy intake, clinical, and biochemical data were collected at baseline, 6 months, and 12 months. End points were all-cause mortality by 12 September 2014. The mean follow-up time was 60.21 (± 24.45) months (11.00 – 89.00).ResultsCompared with the baseline, the mean value of ASM in CAPD patients decreased at 12 months (19.40 ± 5.60 vs 21.85 ± 6.14, p < 0.001). According to the estimation of patient survival by Kaplan-Meier, patients with a shortage of ASM had a worse survival rate than those with normal ASM (χ2= 16.588, p < 0.001). In the Cox's proportional hazards model, patients’ survival was independently associated with a shortage of ASM (hazard ratio [HR] = 2.318, p = 0.024, 95% confidence interval [CI] = 1.116 – 4.812). Standard daily protein intake (stDPI) and standard daily energy intake (stDEI) in patients with a shortage of ASM were significantly lower than those in patients with normal ASM in the first follow-up year ( t = 2.067, p = 0.041; t = 3.673, p = 0.001).ConclusionsA shortage of ASM is an independent risk factor for mortality in CAPD patients. Further studies are needed to demonstrate that nutritional intervention helps with improving muscle mass and, consequently, the survival of CAPD patients.

scholarly journals Hemodialysis vascular access in children – A retrospective study in a pediatric dialysis unit

2021 ◽  
Vol 35 (3) ◽  
Author(s):  
Gabriela Teixeira ◽  
◽  
Paulo Almeida ◽  
Norton Matos ◽  
Maria Faria ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Failure Time ◽  
Venous Catheter ◽  
Maintenance Hemodialysis ◽  
Secondary Patency ◽  
Central Venous ◽  
Dialysis Unit

Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history and transplantation history. Data were analyzed to determine the primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.

scholarly journals Long-term results of ventricular septation for double-inlet left ventricle†

2019 ◽  
Vol 56 (5) ◽  
pp. 898-903
Author(s):  
Masatoshi Shimada ◽  
Takaya Hoashi ◽  
Tomohiro Nakata ◽  
Kenichi Kurosaki ◽  
Suzu Kanzaki ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Left Ventricle ◽  
Venous Pressure ◽  
Left Ventricular ◽  
Central Venous ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Double Inlet Left Ventricle

AbstractOBJECTIVESTo review the long-term surgical outcomes of ventricular septation for double-inlet left ventricle and reconsider the possibility of ventricular septation as an option of surgical treatments.METHODSBetween 1978 and 1994, 22 patients with double-inlet left ventricle underwent ventricular septation. The mean age at operation was 5.3 years (range 0–22 years). Follow-up was carried out in 20 of 22 patients (91%) and the mean follow-up period was 14.7 years (range 0–39 years).RESULTSActuarial survival and reoperation-free survival rates at 30 years were 49% and 21%, respectively. To date, 8 patients have been followed up. Among them, atrioventricular valve replacement and permanent pacemaker were required in 4 and 7 patients, respectively. Late cardiac catheter examination at 25.5 years after surgery showed that the median cardiac index was 2.6 l/min/m2 (range 2.1–3.4 l/min/m2), left ventricular end-diastolic pressure was 7 mmHg (range 4–11 mmHg), left ventricular ejection fraction was 50% (range 27–63%), right ventricular ejection fraction was 53% (range 31–66%) and central venous pressure was 6 mmHg (range 4–11 mmHg). At the latest follow-up, the New York Heart Association Functional Classification was I for 5 patients, II for 2 patients and III for 1 patient. The median peak oxygen uptake was 52.9% (range 44.1–93.5%).CONCLUSIONSSome patients with double-inlet left ventricle were able to maintain low central venous pressure and a sufficient cardiac index long after ventricular septation. Although the single ventricle strategy remains a first-line treatment, ventricular septation can be a surgical treatment option.

The Outcome of Treatment of Flexor Sheath (seed) Ganglia by a Percutaneous Partial Pulley Release

2017 ◽  
Vol 22 (02) ◽  
pp. 219-221
Author(s):  
David Lavalette ◽  
Grey Giddins
Keyword(s):  
Complete Resolution ◽  
Retrospective Cohort ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Percutaneous Release ◽  
Long Term Follow Up ◽  
Local Tenderness ◽  
The Mean

Background: The aims of this study were to assess the safety and efficacy of a technique of partial percutaneous pulley release. Methods: A retrospective cohort study was undertaken treating adults with seed ganglia with a percutaneous pulley release. The patients were reviewed independently after a mean of 6 (range 6–36) months. Results: We treated 24 patients over a 3 year period. There were 14 women and ten men. The mean age was 39 (range 17-65) years. We were able to assess 21 patients with long term follow up. There was complete resolution in 14 (2/3) and partial resolution in four. The remaining three patients had persisting symptoms and requested open surgical excision. Apart from local tenderness and failure of resolution there were no complications of percutaneous pulley release. Conclusions: Bursting or aspiration of flexor sheath ganglia appears to be the best primary treatment. If the ganglion recurs, this study suggests a percutaneous release is safe and will resolve the symptoms in most patients.

Management of Hereditary Hypercoagulable Disorders

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 444-449 ◽  
Author(s):  
Paula L. Bockenstedt
Keyword(s):  
Venous Thromboembolism ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Benefit Analysis ◽  
Central Venous ◽  
Hereditary Factors ◽  
Thrombophilia Screening ◽  
Thrombotic Complications ◽  
Risk Benefit Analysis

Abstract The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome.

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