PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 12430095

Improving dialysis access management.

Neenoo Khosla·Shubhada N Ahya
View original source ↗Export metadata ↓

Abstract

Renal replacement therapy requires either placement of a functional hemodialysis vascular access or peritoneal dialysis catheter. Early provision of a dialysis access improves patient care with reduction in morbidity and reduces the economic burden incurred as a result of delayed access placement. Vascular access dysfunctions (thrombosis and infection) pose the greatest burden on the end-stage renal disease population. This article reviews the current literature on the planning of dialysis access, with particular emphasis on issues pertaining to vascular access. Current concepts to maximize access patency and efficiently manage vascular access complications are highlighted.

Explore related subjects

Arteriovenous Shunt, SurgicalHumansKidney Failure, ChronicPostoperative ComplicationsRenal Replacement TherapyJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Neenoo Khosla, Shubhada N Ahya. 2002. Improving dialysis access management.. https://doi.org/10.1053/snep.2002.35967

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

In vitro paclitaxel and radiation effects on the cell types responsible for vascular stenosis: a preliminary analysis.

Hemodialysis vascular access dysfunction as a result of venous neointimal hyperplasia in dialysis access grafts and fistulae is currently a huge clinical problem. The aim of this study was to assess the effects of paclitaxel and radiation, both singly and in combination on the proliferation of cell types present within the lesion of venous neointimal hyperplasia (vascular smooth muscle cells, fibroblasts and endothelial cells within the neointimal microvessels). Vascular smooth muscle cells, fibroblasts and endothelial cells were plated onto 96-well plates and exposed to different concentrations and doses of paclitaxel and radiation, respectively (both individually and in combination). Growth inhibition was assessed with an MTT assay. Both paclitaxel and radiation resulted in significant growth inhibition of all three cell types. However, even small doses of paclitaxel appeared to attenuate the antiproliferative effect of radiation on these cell types. Further experiments to elucidate the mechanism behind these findings could result in a better understanding of combination antiproliferative therapies.

Arteriovenous Shunt, Surgical↗
PubMed2006

Increasing AV fistulae and decreasing dialysis catheters: two aspects of improving patient outcomes.

Maximizing arteriovenous (AV) fistula prevalence and minimizing catheter use have become the dominant issues in hemodialysis vascular access management and offer the promise of improved patient outcomes with decreased overall expenditures. Recent efforts have increased AV fistula prevalence in the US to 42.9% with regional rates as high as 59.5% and with complementary declines in AV grafts. This should decrease access procedures but may not fully realize the potential reductions in mortality and cost possible if combined with catheter reduction. Successful catheter reduction requires similar approaches to those utilized in the Fistula First Program. Educating patients, the use of clearly defined protocols and updating payment systems to include chronic kidney disease care are crucial to continued progress. Expansion of the Fistula First Program to include a focus on decreasing catheter prevalence and complications should be considered as a requirement in the push toward the breakthrough targets of 66% AV fistula prevalence.

Arteriovenous Shunt, Surgical↗
PubMed2006

Pre-operative radial arterial diameter predicts early failure of arteriovenous fistula (AVF) for haemodialysis.

INTRODUCTION: Long term patency of arteriovenous fistula (AVF) is relevant to the management of end stage renal failure (ESRF) patients on haemodialysis (HD). We evaluated the role of routine radial arterial duplex for imaging radial artery before AVF formation to investigate the relationaship between radial artery internal diameter (ID) and AVF patency. METHODS: 21 patients with ESRF were examined by duplex sonography before AVF formation, 1 day, 1 week, 4 week and 12 weeks post AVF formation. For assessment of AVF patency, patients were divided into 2 groups. Group-1, 11 patients with radial artery ID <1.5mm and Group-2, 10 patients with radial artery ID >1.5mm. Measurement of radial artery blood inflow rate was calculated from mean blood flow velocity and vessel diameter. All AVFs were constructed on the forearm using autologous veins. RESULTS: In Group-1, 5 patients (45%) showed immediate thrombosis of AVF graft. All patients in group-2 had patent AVF at 12 weeks. Pre-AVF formation radial artery blood inflow rate between two groups was not significantly different (p=0.06). Radial artery blood inflow rate was consistently and significantly higher in group-2 at all later time points with p value of <0.01 (Mann Whitney test). CONCLUSION: There was a high failure rate of AVF with radial artery ID of <1.5mm. In the presence of small radial arteries primary access AVF in the upper arm should be considered.

Arteriovenous Shunt, Surgical↗