Hemodialysis vascular access

Beathard GA. Thrombosis associated with chronic hemodialysis vascular access Catheters. In Rose BD, ed. UpToDate. Wellesley, UpToDate, 2003. 

Vancomycin is the drug of choice against serious infections caused by methicihin-resistant strains of Staphylococcus aureus and coagulase-negative staphylococci [172]. It may also be used for treatment of infections by gram-positive organisms in penicillin-intolerant patients. Vancomycin has been extensively used to treat endocarditis caused by streptococci, enterococci and staphylococci. The empiric treatment of intravenous catheter sepsis and hemodialysis vascular access infection by vancomycin has led to a linear increase in its use in the last decade [173]. Oral vancomycin is efficacious in the treatment of Corynebacterium difficile-mediated diarrhea. Of major concern is the recent emergence of vancomycin-resistant enterococcus strains [174,175]. 

The complication and patency rates of PTFE and PU grafts implanted for hemodialysis vascular access were compared by Kiyama et al. " by a long-term follow up of 53 patients who received 58 arteriovenous grafts between 1997 and 2000. Both problem-free (primary) and functional (secondary) patency rates for PU and PTFE grafts were similar at 1 year and 2 years. 

Beathard GA Thrombosis Associated with Chronic Hemodialysis Vascular Access Catheters. UpToDate Topic 1906, version 3.0. 2014. 

Lopot F, Nejedly B, Sulkova S, Blaha J Comparison of different techniques of hemodialysis vascular access flow evaluation. J Vase Access 2004 5 25-32. 

Roy-Chaudhury P, Sukhatme VP, Cheung AK Hemodialysis vascular access dysfunction a cellular and molecular viewpoint. J Am Soc Nephrol 2006 17 1112-1127. 

Perl J, Wald R, McFarlane P, et al Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 2011 22 1113-1121. 

Allon M, Robbin ML Hemodialysis vascular access monitoring current concepts. Hemo-dial Int 2009 13 153-162. 

FM Upper extremity ischemia and hemodialysis vascular access. Eur J Vase Endovasc... 

Becker BN, Breiterman-White R, Nylander W, et al Care pathway reduces hospitalizations and cost for hemodialysis vascular access surgery. Am J Kidney Dis 1997 30 525-531. 

After submission of a paper, the editors of a journal will start the review process in order to critically investigate the paper and to improve its quality. For publication about hemodialysis vascular access, one can publish in different papers depending on the research question of the paper and the methodological quality. Table 2 summarizes the impact factor of journals in which peer-reviewed papers can be found dealing with dialysis accesses [15]. The table further shows clearly a lack in RCTs in the domain of vascular access and that more well-designed studies are mandatory to improve patient safety in regard of treatment strategies. 

MV2101 — Vascular access failure in hemodialysis patients ... 

Vascular access thrombosis has been reported in up to 26% of patients treated with epoetin alfa (3,34,38). Most of the failures occurred in poljdetrafluoroethylene grafts. There was no comparison with patients not treated with epoetin. It has been suggested that the increased risk of extracorporeal circuit clotting and the higher heparin requirements during hemodialysis may not be due to a hypercoagulable state, but rather to an increase in erythrocyte mass and consequently in whole blood viscosity (66). 

El Minshawy O, Abd El AzizT, Abd El Ghani H. Evaluation of vascular access complications in acute and chronic hemodialysis. Vase Access. 2004 5 76-82... 

Besarab A, Raja RM. Vascular access for hemodialysis. In Daugirdas IT, Blake PG, Ing TS, eds. Handbook of Dialysis. Philadelphia, Lippincott Williams Wilkins, 2001 67-101. 

Kaufman JL. Major complications from vascular access for chronic hemodialysis. In Nissenson AR, Fine RN, eds. Dialysis Therapy. Philadelphia, Hanley Belfus, 2002 31-40. 

Intravenous administration in the dialysis center has been practical and effective for patients undergoing hemodialysis [51, 52], but impractical for patients without vascular access who are receiving peritoneal dialysis. Studies of subcutaneous administration showed lower but more sustained peak plasma EPO concentrations (Cmax) than occurred using the intravenous route. The efficacy of subcutaneous administration supports the concept of a sustained minimal effective EPO concentration. High Gnax values after intravenous administration appear unnecessary the dose response relationship seen with intravenous administration most likely correlates with serum EPO concentrations maintained above a minimal effective level. 

C. Hemoperfusion. Using equipment and vascular access similar to that for hemodialysis, the blood is pumped directly through a column containing an adsorbent material (either charcoal or Amberlite resin). Systemic anticoagulation is required, often in higher doses than for hemodialysis, and thrombocytopenia is a common complication. 

Complications that occur during hemodialysis and hemofiltration can be divided into problems related to vascular access and those due to exposure of the blood to the exchange circuit Depending upon the method used, vascular access problems associated with renal replacement therapy are similar to those experienced in patients with vascular grafts or catheters and are covered in those respective sections. 

Catheters are placed when there is a clinical need for repeated sampling, injection, or vascular access, usually on a temporary basis. In kidney failure, catheters allow emergent blood access for hemodialysis and hemofiltration (Canaud, 2000), and provide temporary access as more permanent sites such as arteriovenous fistulas or grafts mature rerotola, 2000). Placement of a catheter or access port is routine for the administration of chemotherapeutic agents and intravenous nutritional supplements. Catheters are often placed when frequent, repeated doses of medication are to be injected. 

Autologous vein is also an important biomaterial used to create AVF that are used for vascular access during hemodialysis. Patients with ESRD undergo hemodialysis in order to avoid life threating uremia and electrolyte imbalance, and creation of an AVF is the critical connection of the patient to the dialysis machine. Unlike vein grafts, the vein to be used for an AVF is not completely removed. Instead, the vein is transected and its proximal portion is joined to a neighboring artery. The vein then adapts to the... 

Bambauer R, Schiel R, Bambauer C, et al. Surface-treated versus untreated large-bore catheters as vascular access in hemodialysis and apheresis treatments. Int J Nephrol 2012 2012 956136. 

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