Comparing non-invasive diagnostic methods for arteriovenous fistula stenosis: a prospective study.

PURPOSE: International guidelines recommend screening for arteriovenous fistula (AVF) stenosis using various non-invasive methods. We evaluate different non-invasive AVF flow measurements for detecting AVF stenosis. METHODS: Twenty-three haemodialysis patients with suspected AVF stenosis are enrolled based on abnormal physical signs or high venous pressure during dialysis. Ultrasound dilution, urea dilution, Doppler ultrasonography, and fistulography are performed on all patients. The accuracy of three non-invasive methods is compared. RESULTS: Fistulography reveals AVF stenosis in 18 patients, 12 of whom have severe stenosis (greater than 50% stenosis in diameter). Concerning the location of the stenosis lesions, eight are at the inflow site, six at the outflow site, and four on both sites. Receiver operating characteristic curve analysis shows that Doppler ultrasonography has a high discriminative ability and the averaged areas under the curves are 0.933 (95% confidence interval [CI]; 0.81 to 0.99) for stenosis and 0.929 (95% CI 0.82-0.99) for severe stenosis. The sensitivity of each method for the prediction of access stenosis using ultrasound dilution, urea dilution, and Doppler ultrasonography is 73%, 73%, and 80%, respectively. The respective specificity of each method is 40%, 80%, and 100%, respectively. Physical examination (PE) shows an 80% sensitivity and 80% specificity in the detection of AVF stenosis. The combination of Doppler ultrasound with PE produces the highest sensitivity (93%) for detecting AVF stenosis. CONCLUSIONS: Doppler ultrasound combined with physical examination is more accurate than other non-invasive methods for detecting AVF stenosis.

Evaluation of different methods to improve culture-negative peritoneal dialysis-related peritonitis: A single-center study.

BACKGROUND: ISPD recommends culture-negative peritonitis in each peritoneal dialysis (PD) center should less than 15%. The hospital in Thailand, however faced a significantly high rate of culture negative peritonitis, even using blood culture bottles technique. This study evaluates the performance of three different culture methods in detecting organisms in PD related peritonitis. METHODS: A prospective cohort diagnostic study was performed in PD patients diagnosed with PD related peritonitis in Surin Hospital from October 2018 to June 2020. The Diagnosis of peritonitis was followed ISPD guidelines. PDF sample from each patient was processed by three different blood culture bottle-based techniques, including i) 50 ml PDF centrifugation, and ii) 10 ml PDF centrifugation before inoculated into blood culture bottles, and iii) inoculation into blood culture bottles without centrifugation. The sensitivities and isolated organisms were compared among the individual methods. RESULTS: Of 126 PD patients with clinical peritonitis, PD related peritonitis was diagnosed in 87 patients with 105 PDF analysis. PDF culture showed gram-positive organisms 34%, gram-negative organisms 41%, fungal 5.71%, and culture-negative result in 22.86%. The direct blood culture method was positive in 59.05%, while centrifugation before inoculated into blood culture bottles, has a higher percentage of positive results, 60.95% and 64.76% from 10 ml to 50 ml PDF volume; respectively. The sensitivity was 84% and 76.5% for 50 ml PDF centrifugation and blood culture without centrifugation. CONCLUSION: Large volume PDF centrifugation before inoculating into blood culture bottles may improve the positive culture rate in PD related peritonitis.

The survival analysis of tunnel-cuffed central venous catheter versus arteriovenous hemodialysis access among elderly patients: A retrospective single center study.

BACKGROUND: There is currently a controversy for the optimal vascular access option in the elderly, regarding their multiple comorbidities and life expectancies. Our study aimed to compare the survival of tunneled cuff venous catheter (CVC) and arteriovenous access (AV access) in elderly patients. METHODS: A retrospective cohort study was performed by electronic medical record review. All hemodialysis patients aged 65 years and over who firstly initiated dialysis from January 1, 2012 to December 31, 2016 at Siriraj hospital, Thailand, were included. The primary outcomes are to compare a 2-year period of survival between CVC and AV access in terms of abandonment, death, and combined outcome. Propensity score covariate and Charlson Comorbidity Score (CCI) were used for multivariable analysis adjustment. RESULTS: A total of 359 patients were included; 216 (60.2%) patients had initiated hemodialysis via CVC while the rest used AV access. The patients' average ages were 76.7 ± 7.0 and 74.0 ± 5.8 years (p-value<0.001) in the CVC and AV access group, respectively. The 2-year mortality rates of CVC and AV access groups were 24.1% and 15.4%, respectively (p-value = 0.038). Multivariable analyses showed that the adjusted hazard ratio (aHR) of combined endpoints, i.e., vascular access abandonment and death, was statistically different only in the CCI-adjusted model (aHR = 0.68, 95% CI: 0.46-0.99). Mortality from infection cause was more common in the CVC group than the AV access group. CONCLUSION: CVC access maybe considers an alternative option for frail elderly patients. However, the patient selection is a crucial issue, given higher infection-related mortality in patients using CVC.

Jejunal perforation during peritoneal dialysis catheter placement: A case report.

INTRODUCTION: Bowel perforation is a rare but serious complication after peritoneal dialysis (PD) catheter insertion, which significantly increases mortality. Currently, there is no recommendation for preferring catheter insertion technique, since neither open surgical or percutaneous technique demonstrate superior outcome. PRESENTATION OF CASE: This is a 78-year-old man who developed jejunal perforation during PD catheter placement, presenting with initial clear and satisfying PD fluid drainage. Bowel perforation was recognized after long dwell of PD fluid returned in yellowish color. Operative finding revealed a through and through jejunal wall perforation. CONCLUSION: Satisfying dialysate flow and tip catheter location could not exclude accidental bowel perforation after PD catheter placement. Carefully patient monitoring is crucial in detecting postoperative complication.

Patients with rheumatoid arthritis have an increased risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies.

OBJECTIVES: Patients with rheumatoid arthritis (RA) may have a higher risk of developing chronic kidney (CKD) compared with general population, but the data on this risk are still not well characterized. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available studies. METHODS: A systematic review was performed using MEDLINE and EMBASE database from inception to July 2019 to identify all cohort studies that compared the risk of developing CKD after index date among patients with RA versus individuals without RA. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect, generic inverse-variance method of DerSimonian and Laird. RESULTS: A total of four cohort studies (three retrospective cohort studies and four prospective cohort study) comprising of 1,627,833 participants met the inclusion criteria and were included in the meta-analysis. The overall quality of the included studies was good. The risk of incident CKD was significantly increased among patients with RA with the pooled risk ratio of 1.52 (95% CI 1.28-1.80). The statistical heterogeneity was high with an I2 of 82%. CONCLUSIONS: A significantly increased risk of incident CKD among patients with RA compared with individuals without RA was demonstrated in this study.

Psoriasis and risk of incident chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis.

OBJECTIVES: Patients with psoriasis may have a higher risk of developing chronic kidney (CKD) and end-stage renal disease (ESRD) compared with general population. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available evidence. METHODS: A systematic review was performed using MEDLINE and EMBASE database from inception to January 2018 to identify all cohort studies that compared the risk of incident CKD and/or ESRD in patients with psoriasis versus individuals without psoriasis. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse variance method. RESULTS: A total of four retrospective cohort studies with 199,808 patients with psoriasis were included. The risk of incident CKD and ESRD was significantly increased among patients with psoriasis with the pooled risk ratio of 1.34 (95% CI, 1.14-1.57) and 1.29 (95% CI, 1.05-1.60), respectively. CONCLUSION: A significantly increased risk of incident CKD and ESRD among patients with psoriasis compared with individuals without psoriasis was demonstrated in this study.