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Sensing Savvy

Trial Evaluates Impact of Access Blood Flow Surveillance on Reduction of Thrombosis in Arteriovenous Fistulas

Posted by Deborah Brouwer-Maier RN, CNN on Nov 28, 2016 7:00:00 AM

Clinicians from the Hospital Infanta Sofía, Madrid, Spain, undertook a three-year follow-up multicenter, prospective, open-label, controlled RCT to determine the impact of access blood flow surveillance in AV fistulas.

The group acknowledged at the outset that surveillance remains controversial because randomized RCTs failed to consistently demonstrate the benefits of flow-based surveillance even though vascular access clinical guidelines recommend monitoring and surveillance protocols to prevent vascular access thrombosis.

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Topics: Hemodialysis

Pediatric Vascular Access Surveillance Examined at Boston Children's Hospital

Posted by Deborah Brouwer-Maier RN, CNN on Nov 23, 2016 6:30:00 AM

Pediatric nephrologists at Boston's prestigious Children's Hospital recognized that an arteriovenous (AV) access is the preferred vascular access for dialysis delivery in children and adolescents requiring chronic hemodialysis (HD). They also understood that, because of the small size of the accesses, maintenance of an access after it is created becomes all the more important and difficult.

Ultrasound dilution (UD) monitoring of AV access flow is widely used in adult HD units for early stenosis detection, but its experience in pediatrics is limited. Therefore, the Boston group they undertook a study to examine its usefulness in children and adolescents.

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Topics: Clinical Trends, Hemodialysis

Italian Nephrologists Evaluate Arteriovenous Fistula Flow and Cardiac Output in Hemodialysis Patients

Posted by Deborah Brouwer-Maier RN, CNN on Nov 21, 2016 7:00:00 AM

Carlo Basile and colleagues from hospitals in Manduria, Italy, were among the first to recognize the relationship between vascular access flow of arteriovenous fistulas (AVFs) and cardiac output (CO). In 2008 they conducted a study to glean better insight into this rarely explored aspect of HD pathophysiology.

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Topics: Hemodialysis

The Cardiovascular Effects of Arteriovenous Fistulas: A Cause for Concern?

Posted by Deborah Brouwer-Maier RN, CNN on Nov 16, 2016 6:30:00 AM

Jennifer MacRae and her colleagues from the University of Calgary, Calgary, Alberta, Canada, reviewed the hemodynamic and cardiovascular consequences of arteriovenous fistulas. Their findings were published in a 2006 paper in Seminars in Dialysis.

MacRae identified three periods when the presence of an AV fistula influences a patient's hemodynamics.

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Topics: Clinical Trends, Hemodialysis

High School Student Sparks Development of First Portable Dialysis Machine

Posted by Susan Eymann, MS on Nov 9, 2016 7:00:00 AM

The first hemodialysis machines at the University of Washington weighed about 1,000 pounds. They were bulky and could only treat one patient at a time. Using them cost about $10,000 annually.

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Topics: Hemodialysis

The Maytag and Nose-Cone Artificial Kidneys

Posted by Susan Eymann, MS on Nov 7, 2016 7:00:00 AM

During the early days of dialysis, in the 1960s, only a few patients could be treated, and even then at great cost. This was unacceptable to W.J. Kolff, the inventor of the first artificial kidney.

As head of the Department of Artificial Organs at the Cleveland Clinic, Kolff wanted to make dialysis so reasonable that anyone could afford it. In his biography, Inventor for Life, The Story of W.J. Kolff, Father of Artificial Organs, Herman Broers relates how Kolff went in search of a way to allow kidney patients to dialyze at home to relieve the pressure of limited beds in dialysis centers. In 1966, Kolff and his team arrived at a solution.

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Topics: Clinical Trends, Hemodialysis

Kidney Care News to Know for November

Posted by Deborah Brouwer-Maier RN, CNN on Nov 2, 2016 6:30:00 AM

Lower Mortality and Dialysis Patients

Researchers found a fistula attempt could be a “surrogate marker for a healthy patient who has had good care prior to starting dialysis,” while catheters were preferred for patients who had a short life expectancy, an acute kidney injury or poor blood vessels.

The researchers also discovered that excess mortality rates in dialysis patients with catheters do not appear to be due to access-related complications but rather the result of “residual confounding, unmeasured comorbidity, or treatment selection bias.”

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Topics: Hemodialysis

Scribner Shunt Ushers In New Era for End-stage Kidney Disease Treatment

Posted by Susan Eymann, MS on Oct 31, 2016 7:00:00 AM

Before 1960, end-stage kidney disease was always fatal. According to a University of Washington research study: “Use of the artificial kidney—or kidney dialysis—to cleanse the blood of toxic products meant that an artery and a vein were damaged every time the patient was hooked up to the machine. A patient could receive perhaps five to seven treatments before doctors would literally run out of places to connect the machine to the patient and the patient would ultimately succumb to the disease.”

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Topics: Hemodialysis

Causes of Sudden Death in Hemodialysis Patients

Posted by Susan Eymann, MS on Oct 26, 2016 6:30:00 AM

Up to one in four hemodialysis patients will die suddenly. These deaths occur most often during the 12 hours immediately following the hemodialysis session or toward the end of the long 72-hour weekend interval between dialysis sessions.

The causes of sudden death in hemodialysis patients are not known. Many patients do not seem to have the typical high-risk factors such as coronary artery disease and heart failure that are associated with sudden death (SCD) in the general population. Their sudden deaths may be related to symptoms associated with chronic kidney disease itself such as vascular calcification, left ventricular hypertrophy, electrolyte/fluid abnormalities, autonomic dysfunction or inflammation.

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Topics: Hemodialysis

Kidney Care News to Know from September

Posted by Deborah Brouwer-Maier RN, CNN on Oct 7, 2016 7:00:00 AM

Frenovia Renal Research will be opening an office in Durham, North Carolina. The company is a subsidiary of Fresenius Medical Care North America and will also expand staff at its locations in New York, Illinois, Florida and Louisiana in addition to North Carolina.

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Topics: Hemodialysis