Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
dialysis shunt [keywords]
- Hemodialysis in children: eleven years in a single center in egypt. [Journal Article]
- Iran J Kidney Dis 2013 Nov; 7(6):468-74.
Introduction.The objective of this study was to report the clinical characteristics and outcomes of children with end-stage renal disease under regular hemodialysis in a dialysis unit in Egypt. Materials and Methods. Ninety children with end-stage renal disease were included in this study and their charts over the past 11 years (from January 2001 to January 2012) were reviewed.
Results.The mean age of the patients at the start of hemodialysis was 5.6 +/- 1.4 years. The main causes of end-stage renal disease were glomerular diseases (35.6%), unknown etiology (33.3%), and urological problems (17.8%). Hospital admissions were due to hypertensive attacks, cardiac problems, arteriovenous shunt complications, and infections. Only 3 children received a kidney transplant and 24 (26.7%) died during the 11-year follow-up. Eight patients died of heart failure, 5 due to sepsis, and 4 due to unexplained causes.
Conclusions.Maintaining an appropriate care for children with end-stage renal disease is quite difficult in developing countries due to factors such as late referral, poor medical service utilization, limitation of financial resources, and limitations to transplantation. As a result, maintaining on hemodialysis for long periods imposes a high risk of complications.
- [Management of shunt thrombosis]. [English Abstract, Journal Article]
- Zentralbl Chir 2013 Oct; 138(5):570-4.
The shunt thrombosis is the most frequent complication of dialysis shunts in haemodialysis patients. Morphological reasons are the main causes of shunt occlusion. A critical evaluation of this aspect is presented on the basis of our own experience.A retrospective study investigated our own procedure of 136 operations between 2007 and 2011 on occluded haemodialysis shunts of the arm. The patient population comprised 49 thrombosed Cimino shunts, 64 PTFE and 23 occluded venous shunts for haemodialysis within a period of four weeks. The thrombosed PTFE shunts showed a recurrence rate of 48 %. There was a maximum of 9 previous operations on renewed occluded shunts. For the patency rates, the reocclusions and the intraoperative abandoning of the shunt were added. Preoperative duplex and angiography were performed on average in 20 % all of the cases.All of the occluded Cimino shunts were treated successfully by thrombectomy in addition to a new anastomosis (38 out of 49, 78 %). The thrombosed PTFE loops for thrombectomy alone in 6 of 11 cases (54 %) and with additive corrections of the anastomosis showed in conclusion a patency rate of 64 % (16 out of 25). A complete new shunt reconstruction of the occluded PTFE shunts was necessary in 14 cases (22 %) and achieved patency rate of 85 %. For the venous loops anastomosis corrections were successful in 8 of 11 cases (72 %). The complete new shunt reconstructions, over bypass procedures or graft interpositions showed the best statistically significant results (χ2 = 3.9; p < 0.05) in comparison to the other procedures. Concerning time management both the day Monday and the weekend were troublesome.The creation of a new anastomosis is the preferred method in the treatment of an occluded Cimino shunt. The sole thrombectomy and correction of the venous anastomosis is often insufficient. The most important aspect in cases of occluded PTFE loops is a completely new shunt reconstruction including interposition and over bypass. The need to perform the operations in good time is obvious, but not necessary in every case at night.
- Ultrasound as a tool for preoperative planning, monitoring, and interventions in dialysis arteriovenous access. [Journal Article, Review]
- AJR Am J Roentgenol 2013 Oct; 201(4):W539-43.
The rising prevalence of end-stage renal disease has resulted in increasing focus on delivery of vascular access care for hemodialysis. Duplex Doppler ultrasound, with its unique ability to reliably evaluate both structural and functional aspects of the peripheral vessels, is the preferred imaging modality for access planning and follow-up.This article will review how ultrasound is currently used to evaluate patients pre-, intra-, and postoperatively for vascular access.
- Patient-specific prediction of ESRD after liver transplantation. [Journal Article]
- J Am Soc Nephrol 2013 Dec; 24(12):2045-52.
Incident ESRD after liver transplantation (LT) is associated with high post-transplant mortality. We constructed and validated a continuous renal risk index (RRI) to predict post-LT ESRD. Data for 43,514 adult recipients of deceased donor LT alone (February 28, 2002 to December 31, 2010) were linked from the Scientific Registry of Transplant Recipients and the Centers for Medicare and Medicaid Services ESRD Program. An adjusted Cox regression model of time to post-LT ESRD was fitted, and the resulting equation was used to calculate an RRI for each LT recipient. The RRI included 14 recipient factors: age, African-American race, hepatitis C, cholestatic disease, body mass index≥35, pre-LT diabetes, ln creatinine for recipients not on dialysis, ln albumin, ln bilirubin, serum sodium<134 mEq/L, status-1, previous LT, transjugular intrahepatic portosystemic shunt, and acute dialysis at LT. This RRI was validated and had a C statistic of 0.76 (95% confidence interval, 0.75 to 0.78). Higher RRI associated significantly with higher 5-year cumulative incidence of ESRD and post-transplant mortality. In conclusion, the RRI constructed in this study quantifies the risk of post-LT ESRD and is applicable to all LT alone recipients. This new validated measure may serve as an important prognostic tool in ameliorating post-LT ESRD risk and improve survival by informing post-LT patient management strategies.
- Characterizing Cardiopulmonary Arrest during Interventional Radiology Procedures. [Journal Article]
- J Vasc Interv Radiol 2013 Dec; 24(12):1774-8.
Careful case selection and preparation can prevent most cardiopulmonary arrest (CPA) in the interventional radiology (IR) suite. A series of CPAs was analyzed to provide insight into risk factors for these events.A single-institution CPA database was used to identify all code team activations from January 1, 2005, to May 30, 2011, in the IR department. Medical records were searched for medical history, American Society of Anesthesiologists (ASA) classification, moderate sedation, and outcomes. Procedural data and procedure classification was acquired from the HI-IQ database.There were 36,489 procedures and 23 CPAs during the study period. Of the 23 patients with CPAs, 12 (52%) were male and 11 (48%) female, and average age was 57 years ± 19 (standard deviation). Risk factors included a 56% incidence of diabetes mellitus, 48% incidence of hypertension, and 78% incidence of renal failure. Of the patients with kidney disease, 56% were chronically dialysis-dependent, and an additional 9% were undergoing central venous catheter placement for new hemodialysis. Seventy-eight percent had ASA status of III or greater, and 57% underwent moderate sedation during the procedure. Relative risk of a CPA during dialysis shunt interventions versus arterial interventions was 3.6 (95% confidence interval, 1.0-11.3; P = .045). Eight of 23 (35%) died: one (12%) during resuscitation and seven (88%) after resuscitation (P = .070).The most common comorbidity of patients with CPA in IR was kidney disease, and the most patients who had CPA underwent dialysis access-related procedures.
- [Problems of surgery of vascular access for hemodialysis]. [Journal Article, Review]
- Vestn Khir Im I I Grek 2013; 172(2):97-100.
- Regarding "Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia" and "Using distal revascularization with interval ligation as the primary treatment of hand ischemia after dialysis access creation". [Comment, Letter]
- J Vasc Surg 2013 Sep; 58(3):859-60.
- Factors responsible for increased percent recirculation in arterio-venous fistula among the haemodialysis patients. [Journal Article]
- Bangladesh Med Res Counc Bull 2013 Apr; 39(1):28-33.
Recirculation is an important issue in haemodialysis (HD) patients as increased percent recirculation causes decreased dialysis delivery of the patients. The purpose of the study was to determine the amount and factors of recirculation in those patients. The study was a cross sectional one carried in the Department of Nephrology, Dhaka Medical College and Hospital during October 2010 to September 2011. A total of 118 end stage renal disease patients with arterio-venous fistula who were on HD for more than 3 months were purposively selected. The degree of recirculation was measured with urea based two needle technique method. For each patient distances between arterial and venous and distances of needles from fistula and its directions were recorded. Echocardiography and A-V fistula Colour Doppler Ultrasound were also performed. The mean A-V fistula recirculation was 8.1 +/- 5.5% with a range 0-66%. The most common factors were close proximity and improper arterial and venous needles placement. No difference was observed between diabetic and non diabetic also between hypertensive and normotensive. A-V fistula recirculation is common occurrence in HD patients and the most common factors of recirculation are misplacement and close proximity of needles therefore emphasis should be given on education and training of HD staffs.
- The optimal initial choice for permanent arteriovenous hemodialysis access. [Journal Article]
- J Vasc Surg 2013 Aug; 58(2):539-48.
- [Hepatorenal syndrome: Focus.] [JOURNAL ARTICLE]
- Nephrol Ther 2013 Jul 10.
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis. It develops as a result of abnormal hemodynamics, leading to systemic vasodilatation and renal vasoconstriction. Increased bacterial translocation, various cytokines and systemic inflammatory response system contribute to splanchnic vasodilatation, and altered renal autoregulation. An inadequate cardiac output with systolic incompetence increases the risk of renal failure. Type 1 HRS is usually initiated by a precipitating event associated with an exaggerated systemic inflammatory response, resulting in multiorgan failure. Vasoconstrictors are the basic treatment in patients with type 1 HRS; terlipressin is the superior agent. Norepinephrine can be used as an alternative. Transjugular intrahepatic portosystemic stent shunt may be applicable in a small number of patients with type 1 HRS and in most patients with type 2 HRS. Liver transplantation is the definitive treatment for HRS. The decision to do simultaneous or sequential liver and kidney transplant remains controversial. In general, patients who need more than 8 to 12 weeks of pretransplant dialysis should be considered for combined liver-kidney transplantation.