Arteriovenous fistula aneurysm in patients on regular hemodialysis: prevalence and risk factors.

BACKGROUND/AIMS: Compared to all other complications, literature data about vascular access aneurysm (VAA) are the scarcest. The aim of this cross-sectional study was to evaluate the prevalence of arteriovenous fistula (AVF) aneurysms and to confirm the risk factors for their appearance. METHODS: The presence, number and morphological characteristics of AVF aneurysms were confirmed, and according to the score of AVF aneurysm (the sum of the length and width in cm), patients were classified into group 1 (score ≤12) and group 2 (score >12). Analysis included the last data from the medical records including vascular calcifications score. RESULTS: Out of 181 patients, 150 with native fistula were included in this study. Aneurysmatic changes were detected in 90 (60%) patients, and the majority had two or more aneurysms. VAA were more frequent in patients with adult polycystic kidney disease (ADPKD) than in other diagnostic categories. By using forward stepwise logistic regression, we confirmed that patients on high-flux hemodialysis (HD) had 5.3-fold higher risk, and patients with diabetes mellitus had 5.8-fold less risk for developing AVF aneurysm. While vascular calcification score did not influence the incidence of VAA, higher PWV had significant negative influence on formation of AVF aneurysm (OR 1.25, 95% CI 1.003-1.56, p = 0.047). By ROC curve analysis, it was determined that patients who were longer than 5.7 years on HD had greater risk for developing VAA (area = 0.741, p = 0.000). CONCLUSION: This single-center study confirmed the very high prevalence of VAA (60%). Aneurysms were more frequent in patients with ADPKD and in those who had longer dialysis vintage on high-flux membranes with higher blood flow rate.

[Application of enoxaparin simultaneously with fibrinolysis in patients with acute myocardial infarction with ST-elevation].

INTRODUCTION: Applied simultaneously with fibrinolytic therapy, low-molecular heparin enoxaparin is showing the potential of improving efficacy with rare adverse effects. Our objective was to investigate if enoxaparin with streptokinase (SK) in patients with acute myocardial infarction (AMI) had better effect than unfractioned heparin (UFH). MATERIAL AND METHODS: The patients with AMI with ST elevation where SK was applied, were divided into two groups: 1. In the study group (N=32, SK+E) both SK and enoxaparin were administered (E, 30 mg intravenously before SK, then after SK 80 mg subcutaneously every 12 hours for 3 days); 2. The patients of the control group were given continuous infusion of UFH 4 hours after SK (1000 i.j. per hour, 3 days). Two groups were similar regarding average age, previous coronary events and diabetes mellitus. RESULTS: The reperfusion, depending mostly on fibrinolytic therapy, was successful in both groups (71.9% vs. 65.8%). The recurrent ischemia was less frequent in the group where enoxaparin was used (18.8% vs. 40.6%, p=0.055), as well as heart failure (15.6% vs. 53.2%, p=0,095). There was no difference in adverse effects. CONCLUSIONS: Enoxaparin used simultaneously with streptokinase in patients with AMI with ST elevation was safe and effective. The recurrent ischemia, the parameter of "infarcted" coronary artery reoclusion, is less frequent in patients who had enoxaparin than unfractioned heparin with fibrinolytic therapy.

[Infections as the cause of death in hemodialysis patients--nine-year retrospective analysis].

INTRODUCTION: Patients on maintenance hemodialysis (HD) are at risk for infections. They represent one of the leading causes of death in this patient population which should be considered at high risk for lethal sepsis development. MATERIAL AND METHODS: Fatalities caused by infections in the period from 1997 to 2005 were analyzed retrospectively in order to investigate their frequency and relation to other causes of death. The role of vascular access (VA) and non-access related infections were also investigated Demographic characteristics, primary renal disease, length of time on HD, seasonal variation in deaths, the presence of diabetes, age over 65 and previous treatment with peritoneal dialysis (PD) were observed. RESULTS: Infections were the third leading cause of death (after cardiovascular and cerebrovascular causes) accounting for 10.1% of fatalities. Females were significantly more prevalent in this group in comparison to all other causes of death (63% vs. 41%, chi2=4.807; p<0.05). The difference was insignificant when all the other parameters were analyzed (age and age over 65, diabetes, HD duration, previous PD). Fatalities most frequently occurred in summer, as opposed to spring (insignificant difference). Infections related to VA were predominant, and the most important ones not related to VA were urinary tract infections and lower extremities gangrene. DISCUSSION AND CONCLUSIONS: Our results proved infections to be the important risk factor for mortality in HD patients. It is of great importance to recognize them in their early course and treat vigorously in order to reduce mortality in this population.