bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY
Authors: Bhargava Vinant , Meena Priti , Satwik Ambrish , Srivastava Apurv , Bhalla A K , Gupta Ashwani , Malik Manish , Gupta Anurag , Bedi V S , Rana Devinder Singh 
Published: June 2020

Abstract

Background and Aims
With the increase in the line expectancy of chronic kidney disease in the older population (&gt;60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (&gt;60 years).

Method
Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates.

Results
A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF.

Conclusion
AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.
P1341FACTORS AFFECTING THE ATTAINMENT OF ADEQUATE BLOOD FLOW OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS
Authors: Gjorgjievski Nikola , Dzekova-Vidimliski Pavlina , Stojanoska Ana , Gjorgievska Julija , Dejanov Petar , SELIM GJULSEN , Nikolov Igor , Rambabova Bushljetikj Irena , Petronijevik Zvezdana , Muharremi Shqelkim , Spasovski Goce , Ivanovski Ninoslav , Sikole Aleksandar 
Published: June 2020

Abstract

Background and Aims
An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of our study was determination of factors associated with achieved adequate blood flow (BF) of AVF during 4-th week after creation

Method
: Created AVF in 63 patients with chronic kidney disease (CKD) stage 4, 5 and 5-HD were analyzed in the prospective single center study, from January 2019 to October 2019. Preoperative mapping of blood vessels by Doppler ultrasound (DUS) on the forearm was performed in all patients. All patients were undergoing surgical creation of new forearm AVF (radio-cephalic) by one doctor. The DUS was used for measuring the diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF and again on 1-st day, 2-nd and 4-th week after AVF creation. In addition the BF of AVF was also measured by DUS on 1-st day, 2-nd and 4-th week after AVF creation. The adequate BF of AVF for hemodialysis treatment was defined as ≥ 600 ml/min. Patient gender and age, hemodialysis vintage, diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF were analyzed as factors that were affecting the achieved BF of AVF during 4-th week after creation.

Results
: The average age of patients was 61.31 ± 12.9 years. From all patients, 60.31% (38/63) were men. The adequate BF of AVF (≥600 ml/min) during 4-th week after creation was achieved in 43.54% (27/63) of created AVFs. The blood flow of AVF measured in male gender was significantly higher compared to the blood flow of AVF measured in female gender (576.03 ml/min vs 375.12 ml/min, p=0.004). The age of the patients and hemodialysis vintage were not significantly associated with achieved adequate BF of AVF during 4-th week after creation of AVF. The adequate BF of AVF was achieved in blood vessels with bigger diameter size. The diameter size of the blood vessels with achieved adequate BF was significantly higher compared to the diameter size of the blood vessels without adequate BF (artery radialis : 2.45 mm vs 2.03 mm, p=0.000; artery brachialis: 4.78 mm vs 4.06 mm, p=0.001 and vein cephalica: 3.12 mm vs 2.83 mm, p=0.018).

Conclusion
The gender and the diameter size of artery radialis, artery brachialis and vein cephalica before creation of AVF were significantly associated with achieved adequate BF of AVF (≥600 ml/min) during 4-th week after creation of AVF.
P1342OUTCOME OF ELDERLY PATIENTS AFTER PREDIALYSIS VASCULAR ACCESS CREATION
Authors: Bhat Dr Sanjay , Srivastava Alok , Ahmad Nisar , Rai Priyanka , Singh R P , Srivastava Rohit , ROY A K , Fatima Jalees 
Published: June 2020

Abstract

Background and Aims
Guidelines to create vascular access for elderly patients is guided by a number of factors i.e. competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes, influencing the outcomes in this population . Does early creation of AVF in elderly patients with advanced CKD influence dialysis outcomes needs evaluation.

Method
We conducted a retrospective study among elderly (&gt; 65 years ) who chose to create a permanent vascular access before dialysis initiation were identified between Jan 2014-Jan 2017 in Tertiary care hospital, Lucknow and assessed in 43 elderly patients (aged ≥65 years) with CKD undergoing predialysis AVF .

Results
They were observed for the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. 45.6 % were diabetic, 78.9% were hypertensive, and 14.2 % had peripheral vascular disease. In all, 67% of patients with predialysis AVF initiated dialysis within 1 years of access placement, but the overall risk of dialysis initiation was modified by patient age. Only one half of patients initiated dialysis with a functioning AVF, 47.9% of AVFs were created &lt;90 days before dialysis initiation. The primary patency rates were 42.7% at one year and 37.8 % at 2 years. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF. In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 1 year. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter.

Conclusion
Insertion of an AVF closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD.
P134410 YEARS EXPERIENCE WITH HEMODIALYSIS TUNNELED CATHETERS
Authors: Ancarani Paolo , Amidone Marco , Baratto Elena , Matrisciano Antonella 
Published: June 2020

Abstract

Background and Aims
A well functioning vascular access ( VA) is vital for hemodialysis (HD) patients. To date a native arteriovenous fistula ( NAVF) remains the gold standard but patients vascular characteristics are often not optimal for vascular surgery. A tunneled central venous catheter (tCVC) are becoming increasingly used as permanent dialysis access and are also competitive to NAVF for the easy and safe insertion tecnique. Our retrospective study observe, during a 10 years period, infection rate of tCVC, bacteriologic analysis and cause of removal.

Method
From January 2010 to December 2019, 176 tCVC were placed in 158 patients ( mean age 74 +/- 18) . All tCVC were inserted by nephrologist in internal giugular vein (IGV), subclavian vein (SV) and femoral vein (FV) using ultasonographic guide. Standards protocols, according to European Renal Best Practice (2010) detailing all aspects of preventive care were used. Each tCVC was followed until it was removed or until the end of the study. 62110 days was the follow up period. 143 tCVC wew placed in IGV ( 81,5%), 22 in FV ( 11,5 %) and 11 in SV (7%). The diagnosis of infection was based on clinical evidence and positive blood culture or positive exit site swab, with no sign of other infection site. We considered a tCVC disfunction in case of blood flow less than 250 ml/m'. Event rates were calculated per 1000 catheters days.

Results
Mean tCVC duration was 353 days. We observed a progressive increment in CVC prevalence during the observational period ( from 15% in 2010 to 39% in 2019). Catheter replacement recurred in 19 patients and the main cause of replacement was loss of patency ( 0,3 per 1000 catheter days). We observed 63 catheter related bloodstream infection (CRBI) and 71 exit site/tunnel infection (ESI/TI). Incidence for CRBI was 1 per 1000 catheter days and ESI/TI was 1,14 per 1000 catheter days. In CRBI the most common organism isolated were MRSA (40%) and MSSA (26%) . In ESI/TI the most common organism isolated was Staphilococcus epidermidis (39.5%) . We used systemic antibiotics, local therapy and lock therapy with a 93% resolution without removal. 12 tCVC were removed for recurrent CRBI ( 0,19 per 1000 catheter days).
At the end of the observation 25 tCVC were still in use.

Conclusion
Our data showed an high survival rate of tCVC in hemodialysis patients. We observed CRBI and ESI/TI rates at the lower limits of the data reported in the literature. Infections were successfully treated conservately in most cases. Careful nursing protocol may reduced the frequency of infection and an early diagnosis can facilitate the rescue of the tCVC with systemic/lock therapy or local therapy. We consider in an elderly population with many comorbidities the use on tCVC recommended especially in patients with poor native peripheral vessels, in patients with steal syndrome high risk and also with a low life expectancy.
P1348EFFECT OF CILOSTAZOL ON ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS
Authors: JEON JAE WAN , Ham Young Rok , Kim Haeri , Choi Wonjung , Na Ki Ryang , CHOI DAE EUN , Lee Kang Wook 
Published: June 2020

Abstract

Background and Aims
Permanent vascular access is important in patients requiring hemodialysis. However, among patients requiring hemodialysis, even if arteriovenous fistula surgery is performed, many are unable to undergo hemodialysis with vascular access due to maturation failure.

Method
Using 194 patients who underwent arteriovenous fistula surgery, a cilostazol group (n = 107) and a control group (n = 87) were compared and analyzed for the occurrence of vascular complications.

Results
In the cilostazol group, there were less vascular complications (36.4% vs. 52.9%; p = 0.022), especially maturation failure (2.8% vs. 11.5%; p = 0.016). However, there was no significant difference between the cilostazol group and control group regarding percutaneous transluminal angioplasty (PTA) requirement nor frequency and interval to PTA after vascular surgery. The frequency of reoperations due to vascular injury after the start of hemodialysis after maturation was also significantly lower in the cilostazol group.

Conclusion
These results suggest that vascular access patients may benefit from postoperative cilostazol therapy.
P1351MARKERS FOR AVF DYSFUNCTION; A RETROSPECTIVE ANALYSIS
Authors: Wã¤rme Anna Vb , Stegmayr Bernd , Nasic Salmir , Hadimeri Henrik 
Published: June 2020

Abstract

Background and Aims
The native Arterio venous fistula (AVF) is the recommended first choice for regular hemodialysis treatment. However, its patency is mainly limited due to stenosis and thrombosis, leading to insufficient dialysis, costly interventions, subsequent in-hospital care and follow ups.
Primary aim: To find medical or laboratory markers associated with dysfunctional AVF.

Method
Retrospective analysis of radiologic examinations and medical records was made due to clinical suspicion of AVF dysfunction (cases) from two hospitals during 2006-2014. Comparison was made with data from 52 patients without complications (controls) with repeated blood sampling during the same period. Differences between groups were calculated with Mann- Whitney test and paired statistics with Wilcoxon U test before and after examination.

Results
Mean age in both groups was 65 years. In 153 patients 473 radiological examinations were performed due to clinical suspicion of dysfunction. Angiography and PTA were made when suitable according to guidelines. In 171 of these examinations no intervention was performed. Cases versus controls had lower access flow (599±442 vs 1140±523, p&lt;0.001), blood pump speed (291±49 vs 313±34, p&lt;0.001), PTH (31±39 vs 39±29 pmol/L, p=0,021), Ca-phosphate product (3.9±1.1 vs 4.2±1.0, p=0.025), C-reactive protein (17±25 vs 24±38, p=0.004) and, higher in regard to recirculation (5.1±11 vs 0.5±3.4, p&lt;0.001), HbA1c (52±16 vs 47±17, p=0.027), dose of tinzaparin (14330±8000 vs 12743±5400U/week, p= 0.025), weekly dose of erythropoietin stimulating agent (ESA, 8900±7100 vs 4900±4600U/week, p&lt;0,001), and higher weekly iron supplement dosing (60±61 vs 41±54mg/week, p&lt;0.001). Alfa- and Beta-blockers against hypertension were more often used among cases.

Conclusion
The reason for AVF problems in cases showed limited disturbances in Ca-phosphate hemostasis and inflammation. Instead, it seems that higher dosing of ESA and LMWH (as indicator of clotting) are factors that could be associated with development of AVF malfunction.
P1353IS AGE RISK FACTOR FOR TUNNELED VASCULAR CATHETER OUTCOMES?
Authors: Bajcetic Sanja , Jankovic Aleksandar , Djuric Petar , Stopić Bojan , Naumovic Radomir , Dimkovic Nada 
Published: June 2020

Abstract

Background and Aims
According to previous data, the prevalence of tunnelled cuffed vascular catheters (TCC) is more frequent in elderly as compared to younger HD patients. Still, it is not clear if elderly have decreased survival of TCC as compared with survival in younger.

Method
During the period from January 2010 to June 30, 2015, 110 permanent catheters were implanted in 64 patients (1.72 catheters per patient, 51.6% male mean age 67±12years, 20 diabetics). Out of all patients, 44 (68.7%) were older than 65 years, 12 (27.3%) were diabetic and 11 (25%) were previously treated with peritoneal dialysis. In the age-based subpopulations we compared the incidence of infections, thrombosis, chemical removal of thrombus by actilysis and TCC outcome.

Results
Reasons for TCC placement in elderly were inability of the second option and exhausted vascular approach and these reasons were found to be significantly more frequent compared to patients younger than 65 years (p = 0.020 ). Primary position of TCC was right jugular vein in both groups (39.1%, No = 25 vs 14.1% No = 9), more commonly in group of elderly patients, but there was no significant difference in the initial TCC position depending on the age structure of the patient (Hi square = 1.720, p = 0.886). The overall incidence of infections was 3.44 episodes per 1000 catheter days and patients' age did not affect TCC replacement, infection, thrombosis and inflammation. In the group of elderly, 27 patients had catheter infection (61.4%), 10 (22.7%) had catheter thrombosis and actilysis resolved thrombosis in 6 (13.6%) patients without significant difference as compared with younger patients. Catheter-induced bacteraemia were more common in TCC over 65 years (47 TCC vs. 12 TCC) but without statistical significance (p = 0.062). Similarly, exit site infection, was more common (14 TCC vs. 4 TCC) for those older than 65 years but also without statistical significance. Thrombosis of TCC occurred in 7 patients with TCC younger than 65 years and in 20 TCC in cohort of elderly (Hi square = 0.033, p = 0.535) (Table 1). Regarding treatment outcome, 19 (43.2%) elderly patients died while being treated with TCC, 12 patients (27.3%) changed treatment modality to peritoneal dialysis, 4 patients (9.1%) received arteriovenosus graft (AVG) and 9 patients had functional TCC at the end of follow up (20.5%) and no significant difference was found in the outcome compared to younger patients.

Conclusion
The reason for placement of TCC in elderly is the inability of other treatment options and exhaustion of vascular access. Concerning catheter related complication and outcome, there was no significant difference between the elderly and younger patient.
P1356PACLITAXEL-COATED BALLOON ANGIOPLASTY FOR STENOSIS OF ARTERIOVENOUS FISTULA IN PATIENTS UNDER HEMODIALYSIS: 18TH MONTH FOLLOW-UP
Authors: GRIVEAS IOANNIS , VOURLIOTAKIS GEORGIOS , KANDOUNAKIS IOANNIS 
Published: June 2020

Abstract

Background and Aims
The recording of the experience of the use of paclitaxel-coated balloons in patients with End Stage Renal Disease under hemodialysis (HD) exhibiting narrowing in arteriovenous fistulas (AVF).

Method
20 patients with ultrasonographically confirmed AVF dysfunction were subjected after angiographic screening to prosthesis with a simple angioplasty balloon, and then a balloon drug gradually released the drug paclitaxel. After the damage was restored (one-day clinic), arteriovenous communication was used immediately. The degree of vascular stenosis, blood flow to it and kt / V before and after recovery were assessed by ultrasound. At the same time, the clinical course of the patient and the vestibule of the vessel were monitored for 18 months.

Results
In the 20 patients of the study, since the damage was recovered, AVF was immediately treated without any problems. After angioplasty the degree of stenosis of the responsible vessel was statistically significantly reduced from 69.85% to 27.38% (p &lt;0.05). Flow volume increased statistically significantly from 690.47 mils / min to 942.67 mils / min (p &lt;0.05). The kt / v of patients improved from 1.25 to 1.6. During the 18th -month follow-up, the clinical course of the patients was stable, no problems related to vascular access appeared. Restenosis occurred to two patients, one of each received another successful angioplasty.

Conclusion
Drug-releasing balloons can be a useful therapeutic option for patients with AVF stenosis due to accelerated endothelial hyperplasia. The use of paclitaxel-coated balloons helps reduce the risk of restenosis of arteriovenous anastomoses and is a safe, time consuming, minimal invasive and immediate solution to AVF management.
P1357SODIIUM BICARBONATE CAN REPLACE THE HEPARIN AS “CATHETER LOCK SOLUTION” OF CENTRAL CATHETERS (CVC) FOR HEMODIALYSIS (HD)?
Authors: Corciulo Roberto , Zazzera Pierfelice , Misceo Fernanda , Corciulo Simone , Lomonte Carlo , Libutti Pasquale 
Published: June 2020

Abstract

Background and Aims
The CVC often faces thrombosis and/or infection and currently there are no interventions that guarantee the efficiency of the CVC and the absence of bacterial infections. Recently Adel S. El-Hennawy et al. NDT, 2019, have shown that the use of sodium bicarbonate as “catheter lock solution” (SBCLS) in HD patients has a local anticoagulant effect and reduces the frequency of thrombosis and infections. Therefore, we wanted to use SBCLS in the management of our dialysis patients who needed HD treatment through CVC.

Method
The study included n. 15 HD patients (8M and 7F) with a CVC (see tab.1), whose CVC were previously medicated with heparin or citrate. At the time of the introduction of the SBCLS, patients showed no signs of CVC thrombosis or bacteremia; 2 patients had previously had haemorrhagic complications, 3 had malfunctioning thrombotic CVC. The observation period was 2379 days (mean 158 ± 50). Upon the conclusion of HD treatment, each port of all two-port catheters was flushed and locked with 10 mL of SBCLS (NaHCO3 at 8.4% -pH 7-8.5) and approximately 2 mL of the injected solution remained locked within the catheter. One patient who was allergic to heparin was included in the study.

Results
At the end of the study, only 3 patients had thrombotic problems with CVC and none had infections. However, none of the enrolled patients had to replace the CVC. The treatment was well tolerated by all patients who did not present complications.

Conclusion
In our short and brief experience, SBCLS has proved effective and safe in the prevention of thrombosis and infection of CVC. SBCLS appears to be an effective alternative to heparin and citrate in the management of CVC in the absence of bleeding complications. Finally SBCLS is a valid medical solution in patients allergic to heparin.
P1359PATTERNS OF CENTRAL VENOUS OBSTRUCTION AND OUTCOMES OF ENDOVASCULAR INTERVENTIONS IN CKD PATIENTS ON HAEMODIALYSIS
Authors: Mathur Rajendra , Kalita Dibyajyoti , Mukund Amar 
Published: June 2020

Abstract

Background and Aims
Central Venous Obstruction (CVO) is one of the major causes of morbidity in Chronic Kidney Disease (CKD) patients on maintenance Hemodialysis (HD).
The aim of the study was to assess the patterns of CVO and the role of Endovascular interventions to restore the patency of vascular access in patients on HD with CVO.

Method
We report 15 cases of CVO in HD patients between April 2015 to April 2018. Data regarding patients’ basic information, primary disease, dialysis duration, access at initiation, number and sites of central venous catheterizations, vascular segments stenosed or thrombosed, type of endovascular interventions done and outcomes were collected from electronic record system.

Results
Out of 15 cases of CVO, 11 had the first dialysis with a temporary catheter either to Internal Jugular vein or femoral vein. The average time of presentation to our hospital from initiation of dialysis was 14.8 months. 8 patients presented with symptomatic SVC obstruction. The most common site of CVO was left Brachio-cephalic vein followed by right brachio-cephalic, right subclavian and left subclavian vein. 12 patients underwent Percutaneous Transluminal Angioplasty (PTA) and 3 required bare metal stenting (BMS) along with PTA. One patient required repeat PTA after 4 months. 11 patients did not require further procedure in the mean follow up period of 110 days. PTA was found to be successful in 11 out of 12 cases. Post PTA 9 patients underwent tunneled HD catheter insertion.

Conclusion
Patients of CKD who present late to the nephrologists require HD to be initiated through temporary catheters to central veins. Repeated central venous catheterization is associated with CVO. Endovascular intervention is an effective modality for maintaining HD access patency in such cases.