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1.
Medicine (Baltimore) ; 99(37): e22002, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925731

RESUMO

The use of tunneled cuffed catheters (TCCs) for permanent blood access is increasing as the hemodialysis population ages. However, the higher mortality and complication rates associated with their use have been significant concerns. This single-center observational cohort study aimed to investigate clinical factors affecting mortality and complications in Japanese hemodialysis patients with a TCC.We enrolled 64 consecutive patients receiving hemodialysis through a TCC between 2012 and 2019. The primary outcome was all-cause mortality and the secondary outcome was the incidence of catheter-related complications at 2 years. Cox proportional hazards models were used to examine variables associated with these outcomes.At 2 years, death from any cause and catheter-related complications occurred in 27/64 (42%) and 23/64 (36%) patients, respectively. There were 14 bacteremia events, 7 catheter obstructions, and 8 instances of restricted blood flow. Multivariate analysis showed that systolic blood pressure (SBP) < 100 mm Hg at the time of catheter insertion was associated with higher all-cause mortality (hazard ratio, 2.59; 95% confidence interval, 1.05-6.41) and catheter-related complications (hazard ratio, 2.57; 95% confidence interval, 1.52-22.2). The Kaplan-Meier analyses also showed that patients with SBP <100 mm Hg had higher mortality (P = .001) and a higher incidence of catheter-related complications (P = .0068).SBP <100 mm Hg at the time of catheter insertion is associated with mortality and catheter-related complications in hemodialysis patients using a TCC. Further multi-center studies are required to validate our results.


Assuntos
Pressão Sanguínea , Cateteres de Demora/efeitos adversos , Causas de Morte , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/etiologia , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/etiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/fisiopatologia , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Risco
2.
PLoS One ; 15(8): e0236946, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764790

RESUMO

Hemodialysis catheters are used to support blood filtration, yet there are multiple fundamentally different approaches to catheter tip design with no clear optimal solution. Side-holes have been shown to increase flow rates and decrease recirculation but have been associated with clotting/increased infection rates. This study investigates the impact of changing the shape, size and number of side-holes on a simple symmetric tip catheter by evaluating the velocity, shear stress and shear rate of inflowing blood. A platelet model is used to examine the residence time and shear history of inflowing platelets. The results show that side-holes improve the theoretical performance of the catheters, reducing the maximum velocity and shear stress occurring at the tip compared to non-side-hole catheters. Increasing the side-hole area improved performance up to a point, past which not all inflow through the hole was captured, and instead a small fraction slowly 'washed-out' through the remainder of the tip resulting in greater residence times and increasing the likelihood of platelet adhesion. An oval shaped hole presents a lower chance of external fibrin formation compared to a circular hole, although this would also be influenced by the catheter material surface topology which is dependent on the manufacturing process. Overall, whilst side-holes may be associated with increased clotting and infection, this can be reduced when side-hole geometry is correctly implemented though; a sufficient area for body diameter (minimising residence time) and utilising angle-cut, oval shaped holes (reducing shear stress and chances of fibrin formation partially occluding holes).


Assuntos
Cateteres , Diálise Renal/instrumentação , Velocidade do Fluxo Sanguíneo , Plaquetas/citologia , Cateteres/estatística & dados numéricos , Biologia Computacional , Simulação por Computador , Desenho de Equipamento , Hemodinâmica , Humanos , Hidrodinâmica , Modelos Cardiovasculares , Adesividade Plaquetária
6.
CEN Case Rep ; 9(4): 404-408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32557209

RESUMO

On 31 December 2019, cases of pneumonia whose cause was later identified as SARS-CoV-2 were detected in Wuhan City, Hubei Province of China, and now COVID-19 has spread worldwide. On March 1, 2020, a 69-year-old Japanese man who had been on hemodialysis for 3 years was diagnosed as having COVID-19 pneumonia and hospitalized at our Medical Center. Pulmonary CT revealed bilateral multiple consolidation with bilateral pleural effusion. Aggressive weight reduction was needed to improve the patient's respiratory condition. Hemodialysis therapy was performed in isolation with hydroxychloroquine administration, but the formation of a dialysis membrane clot forced the withdrawal of dialysis therapy. Changing the dialysis membrane material and anticoagulant enabled the resumption of dialysis therapy, allowing the body weight to correct downward. On the 5th hospitalization day, the patient's fever dropped and he showed improved oxygenation and chest X-ray. He was eventually discharged. The hydroxychloroquine and appropriate fluid management may have contributed to the patient's recovery. Clinicians should pay close attention to avoid dialysis-related problems when treating a patient with COVID-19.


Assuntos
Infecções por Coronavirus , Hidroxicloroquina/administração & dosagem , Falência Renal Crônica , Pandemias , Derrame Pleural , Pneumonia Viral , Diálise Renal , Idoso , Anti-Infecciosos/administração & dosagem , Anticoagulantes/uso terapêutico , Terapia Combinada , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pulmão/diagnóstico por imagem , Masculino , Membranas Artificiais , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Diálise Renal/instrumentação , Diálise Renal/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Ann R Coll Surg Engl ; 102(8): 601-605, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538115

RESUMO

INTRODUCTION: This study aimed to evaluate the safety and efficacy of paclitaxel-coated balloon compared with conventional plain balloon for the treatment of failing native dialysis access. MATERIALS AND METHODS: This prospective study included 60 patients presenting to the Kasr Alainy Hospitals and Aseer Central Hospital in the period from September 2015 to December 2017 with failing native vascular access. Dilatation with a plain balloon was done in 30 patients (group I) and with a paclitaxel-coated balloon in 30 patients (group II) with either stenosis or occlusion. The majority were outflow lesions, with 20 (66.7 %) patients in group I and 21 (70%) patients in group II. Mean balloon diameter was 7.1mm (± 1.5mm) compared with 6.5mm (± 1.2mm) and length 66mm (± 19.1mm) compared with 54.6mm (± 15.7mm), respectively. Safety endpoint was reported as 30 day's freedom from procedure-related major complications and mortality. Procedural technical success was defined as a residual diameter 30% or less for treated lesions. Target lesion primary patency, circuit primary patency and secondary patency were reported at 3, 6 and 12 months. RESULTS: There were no 30-day procedure-related major complications or mortality in either group. Procedural technical success of 100% was achieved in both groups. Target lesion primary patency, circuit primary patency and secondary patency in group II were better than in group I, especially at 12 months (90% vs 66.7%, 83.3% vs 60% and 96.7% vs 93.3%, respectively). There was a statistically significant difference in target lesion primary patency (p = 0.029) in patients who were treated with paclitaxel-coated balloon angioplasties. CONCLUSION: The paclitaxel-coated balloon proved to be safe and effective, and improved the patency of failing vascular access. Results are comparable with previous studies.


Assuntos
Angioplastia com Balão , Materiais Revestidos Biocompatíveis/uso terapêutico , Paclitaxel , Diálise Renal , Dispositivos de Acesso Vascular/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Paclitaxel/uso terapêutico , Complicações Pós-Operatórias , Estudos Prospectivos , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Diálise Renal/métodos , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/prevenção & controle
9.
Circ Heart Fail ; 13(4): e006731, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32295407

RESUMO

Acute decompensated heart failure remains the most common cause of hospitalization in older adults, and studies of pharmacological therapies have yielded limited progress in improving outcomes for these patients. This has prompted the development of novel device-based interventions, classified mechanistically based on the way in which they intend to improve central hemodynamics, increase renal perfusion, remove salt and water from the body, and result in clinically meaningful degrees of decongestion. In this review, we provide an overview of the pathophysiology of acute decompensated heart failure, current management strategies, and failed pharmacological therapies. We provide an in depth description of seven investigational device classes designed to target one or more of the pathophysiologic derangements in acute decompensated heart failure, denoted by the acronym DRI2P2S. Dilators decrease central pressures by increasing venous capacitance through splanchnic nerve modulation. Removers remove excess fluid through peritoneal dialysis, aquaphoresis, or hemodialysis. Inotropes directly modulate the cardiac nerve plexus to enhance ventricular contractility. Interstitial devices enhance volume removal through lymphatic duct decompression. Pushers are novel descending aorta rotary pumps that directly increase renal artery pressure. Pullers reduce central venous pressures or renal venous pressures to increase renal perfusion. Selective intrarenal artery catheters facilitate direct delivery of short acting vasodilator therapy. We also discuss challenges posed in clinical trial design for these novel device-based strategies including optimal patient selection and appropriate end points to establish efficacy.


Assuntos
Denervação Autônoma/instrumentação , Cateterismo/instrumentação , Terapia por Estimulação Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Hemodinâmica , Rim/fisiopatologia , Diálise Renal/instrumentação , Animais , Denervação Autônoma/efeitos adversos , Cateterismo/efeitos adversos , Tomada de Decisão Clínica , Terapia por Estimulação Elétrica/efeitos adversos , Desenho de Equipamento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Seleção de Pacientes , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Fatores de Risco , Resultado do Tratamento
11.
Am J Kidney Dis ; 75(5): 665-683, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279907

RESUMO

The first KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection was published in 2008. The ensuing decade bore witness to remarkable advances in the treatment of HCV infection following the approval of direct-acting antiviral (DAA) agents that deliver cure rates routinely >95%. In this context, the KDIGO organization correctly recognized the need for an updated HCV guideline that would be relevant to the treatment of HCV-infected patients with kidney disease in the DAA era. The current NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) commentary provides an in-depth review and perspective on the 2018 KDIGO guideline. Of note, the KDIGO work group made significant updates to guideline chapters 2 and 4 as a direct result of the availability of DAAs. The intent of this commentary is to provide useful interpretation for nephrologists and other practitioners caring for HCV-infected patients with chronic kidney disease, including dialysis patients and kidney transplant recipients. The availability of DAA agents that are safe and highly effective has created new opportunities, such as the transplantation of kidneys from HCV-infected kidney donors. The ability to treat HCV infection in patients with kidney disease will have a significant impact on the care of our patients and should favorably influence long-term outcomes as well.


Assuntos
Hepatite C , Guias de Prática Clínica como Assunto , Antivirais/farmacologia , Antivirais/uso terapêutico , Infecção Hospitalar/diagnóstico , Gerenciamento Clínico , Seleção do Doador , Diagnóstico Precoce , Contaminação de Equipamentos , Previsões , Genótipo , Hepacivirus/genética , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite C/complicações , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/prevenção & controle , Humanos , Controle de Infecções/métodos , Transplante de Rim , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Programas de Rastreamento , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Pesquisa
12.
J Vasc Interv Radiol ; 31(5): 778-786, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32305244

RESUMO

PURPOSE: Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy. MATERIALS AND METHODS: Single-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled "modifications." CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg. RESULTS: Of the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were ≤1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent ≤6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years. CONCLUSIONS: Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falência Renal Crônica/terapia , Diálise Renal/instrumentação , Fatores Etários , Peso Corporal , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/mortalidade , Desenho de Equipamento , Humanos , Lactente , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Londres; National Institute for Health and Care Excellence; Mar. 20, 2020. 20 p.
Monografia em Inglês | BIGG | ID: biblio-1097103

RESUMO

The purpose of this guideline is to maximise the safety of patients on dialysis, while protecting staff from infection. It will also enable dialysis services to make the best use of NHS resources and match the capacity of dialysis services to patient needs if these become limited because of the COVID-19 pandemic.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Diálise Renal/enfermagem , Diálise Renal/instrumentação , Hemodiálise no Domicílio , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , Unidades Hospitalares de Hemodiálise
15.
Am J Kidney Dis ; 76(1): 82-89, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32151430

RESUMO

RATIONALE & OBJECTIVE: Compared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access-related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. STUDY DESIGN: Descriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data. SETTING & PARTICIPANTS: US patients receiving hemodialysis treated in outpatient dialysis centers. PREDICTORS: AVF cannulation methods, dialysis facility characteristics, and infection control practices. OUTCOMES: Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start. ANALYTIC APPROACH: Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHC versus RLC estimated using Poisson regression. RESULTS: During 2013 to 2014, there were 2,466 access-related bloodstream infections, 3,169 local access-site infections, and 13,726 IV antimicrobial starts among patients accessed using BHC. Staphylococcus aureus was the most common pathogen, present in half (52%) of the BHC access-related bloodstream infections. Hospitalization was frequent among BHC access-related bloodstream infections (37%). In 2014, 9% (n=271,980) of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, BHC was associated with significantly higher risk for access-related bloodstream infection (aRR, 2.6; 95% CI, 2.4-2.8) and local access-site infection (aRR, 1.5; 95% CI, 1.4-1.6) than RLC, but was not associated with increased risk for IV antimicrobial start. LIMITATIONS: Data for facility practices were self-reported and not patient specific. CONCLUSIONS: BHC was associated with higher risk for vascular access-related infection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo/efeitos adversos , Centers for Disease Control and Prevention, U.S. , Diálise Renal/efeitos adversos , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologia , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Centers for Disease Control and Prevention, U.S./estatística & dados numéricos , Estudos de Coortes , Análise de Dados , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
16.
Br J Radiol ; 93(1109): 20190505, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101462

RESUMO

OBJECTIVE: Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. METHODS: Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan-Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. RESULTS: 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36-84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2-84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46-10.09] or anastomosis (HR = 1.90, 95% CI: 1.09-3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22-4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26-4.63) were significantly associated with decreased patency. CONCLUSION: In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. ADVANCES IN KNOWLEDGE: A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/terapia , Procedimentos Endovasculares/métodos , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia
17.
Carbohydr Polym ; 231: 115727, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888849

RESUMO

Carbazate groups were grafted on the commercial cellulose membrane (CM) to specifically scavenge the carbonylated proteins for hemodialysis. It confirmed that carbazate groups were successfully covalently attached on the CMs by XPS and EDS, and the modified CMs still saved their original morphology and crystalline structures by SEM and XRD. Furthermore, the modified CMs presented favorable physicochemical stability at wide pH range from 2.5 to 7.4. It was also found that the carbazate modified CMs could selectively remove carbonylated proteins from acrolein treated bovine serum albumin (BSA) or ESRD patient's blood serum in PBS buffer. The modified CMs showed the potential to be utilized as the substitute of dialysis membranes in hemodialysis.


Assuntos
Celulose/química , Hidrazinas/química , Falência Renal Crônica/terapia , Membranas Artificiais , Acroleína/farmacologia , Celulose/uso terapêutico , Humanos , Hidrazinas/uso terapêutico , Falência Renal Crônica/sangue , Polissacarídeos/química , Carbonilação Proteica/efeitos dos fármacos , Diálise Renal/instrumentação , Soroalbumina Bovina/química
19.
Ren Fail ; 42(1): 30-39, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31847666

RESUMO

Background: Although arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD), the association between vascular access types and quality of life is not well-known. We investigated the relationships between HD vascular access types and all-cause mortality, health-related quality of life (HRQOL) and the degree of depression in a large prospective cohort.Methods: A total of 1461 patients who newly initiated HD were included. The initial vascular access types were classified into AVF, arteriovenous graft (AVG), and central venous catheter (CVC). The primary outcomes were all-cause mortality and HRQOL and depression. The secondary outcome was all-cause hospitalization. Kidney Disease Quality of Life Short Form 36 (KDQOL-36) and Beck's depression inventory (BDI) scores were measured to assess HRQOL and depression.Results: Among 1461 patients, we identified 314 patients who started HD via AVF, 76 via AVG, and 1071 via CVC. In the survival analysis, patients with AVF showed significantly better survival compared with patients with other accesses (p < .001). The AVF and AVG group had higher KDQOL-36 score and lower BDI score than CVC group at 3 months and 12 months after the initiation of HD. The frequency of hospitalization was higher in patients with AVG compared to those with AVF (AVF 0.7 vs. AVG 1.1 times per year) (p = .024).Conclusions: The patients with AVF had better survival rate and low hospitalization rate, and the patients with AVF or AVG showed both higher HRQOL and lower depression scores than those with CVC.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Depressão/diagnóstico , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/instrumentação , Derivação Arteriovenosa Cirúrgica/psicologia , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Depressão/etiologia , Depressão/psicologia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Qualidade de Vida , Diálise Renal/instrumentação , Diálise Renal/métodos , República da Coreia/epidemiologia , Fatores de Risco , Autorrelato/estatística & dados numéricos , Índice de Gravidade de Doença , Taxa de Sobrevida , Grau de Desobstrução Vascular
20.
Eur J Vasc Endovasc Surg ; 59(2): 288-294, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31883684

RESUMO

OBJECTIVE: Arteriovenous grafts (AVGs) typically lose patency within two years of creation due to venous neointimal hyperplasia, which is initiated by disturbed haemodynamics after AVG surgery. Haemodialysis needle flow can further disturb haemodynamics and thus impact AVG longevity. In this computational study it was assessed how dialysis flow and venous needle positioning impacts flow at the graft-vein anastomosis. Furthermore, it was studied how negative effects of dialysis needle flow could be mitigated. METHODS: Non-physiological wall shear stress and disturbed blood flow were assessed in an AVG model with and without dialysis needle flow. Needle distance to the venous anastomosis was set to 6.5, 10.0, or 13.5 cm, whereas dialysis needle flow was set to 200, 300 or 400 mL/min. Intraluminal needle tip depth was varied between superficial, central, or deep. The detrimental effects of dialysis needle flow were summarised by a haemodynamic score (HS), ranging from 0 (minimal) to 5 (severe). RESULTS: Dialysis needle flow resulted in increased disturbed flow and/or non-physiological wall shear stress in the venous peri-anastomotic region. Increasing cannulation distance from 6.5 to 13.5 cm reduced the HS by a factor 4.0, whereas a central rather than a deep or superficial needle tip depth reduced the HS by a maximum factor of 1.9. Lowering dialysis flow from 400 to 200 mL/min reduced the HS by a factor 7.4. CONCLUSION: Haemodialysis needle flow, cannulation location, and needle tip depth considerably increase the amount of disturbed flow and non-physiological wall shear stress in the venous anastomotic region of AVGs. Negative effects of haemodialysis needle flow could be minimised by more upstream cannulation, by lower dialysis flow and by ensuring a central needle tip depth. Since disturbed haemodynamics are associated with neointimal hyperplasia development, optimising dialysis flow and needle positioning during haemodialysis could play an important role in maintaining AVG patency.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/prevenção & controle , Modelos Cardiovasculares , Neointima/patologia , Diálise Renal/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Implante de Prótese Vascular , Cânula/efeitos adversos , Simulação por Computador , Desenho Assistido por Computador , Oclusão de Enxerto Vascular/etiologia , Humanos , Hidrodinâmica , Hiperplasia/etiologia , Agulhas/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Diálise Renal/instrumentação , Diálise Renal/métodos , Estresse Mecânico , Grau de Desobstrução Vascular/fisiologia
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