Clinical Outcomes and Costs Due toStaphylococcus aureusBacteremia Among Patients Receiving Long-Term Hemodialysis

2005 ◽  
Vol 26 (6) ◽  
pp. 534-539 ◽  
Author(s):  
John J. Engemann ◽  
Joëlle Y. Friedman ◽  
Shelby D. Reed ◽  
Robert I. Griffiths ◽  
Lynda A. Szczech ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Tertiary Care ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Initial Hospitalization ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mean Cost

AbstractObjective:To examine the clinical outcomes and costs associated withStaphylococcus aureusbacteremia among hemodialysis-dependent patients.Design:Prospectively identified cohort study.Setting:A tertiary-care university medical center in North Carolina.Patients:Two hundred ten hemodialysis-dependent adults with end-stage renal disease hospitalized withS. aureusbacteremia.Results:The majority of the patients (117; 55.7%) underwent dialysis via tunneled catheters, and 29.5% (62) underwent dialysis via synthetic arteriovenous fistulas. Vascular access was the suspected source of bacteremia in 185 patients (88.1%). Complications occurred in 31.0% (65), and the overall 12-week mortality rate was 19.0% (40). The mean cost of treatingS. aureusbacteremia, including readmissions and outpatient costs, was $24,034 per episode. The mean initial hospitalization cost was significantly greater for patients with complicated versus uncomplicatedS. aureusbacteremia ($32,462 vs $17,011;P= .002).Conclusion:Interventions to decrease the rate of S.aureusbacteremia are needed in this high-risk, hemodialysis-dependent population (Infect Control Hosp Epidemiol2005;26:534-539).

Characteristics and Clinical Outcomes of End-Stage Renal Disease Patients on Peritoneal Dialysis for over 15 Years: A Single-Center Experience

2017 ◽  
Vol 37 (5) ◽  
pp. 535-541 ◽  
Author(s):  
Youn Kyung Kee ◽  
Jung Tak Park ◽  
Chang-Yun Yoon ◽  
Hyoungnae Kim ◽  
Seohyun Park ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
End Stage Renal Disease ◽  
Short Term ◽  
Factors Associated ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Maintaining peritoneal dialysis (PD) for a long time is problematic owing to a number of factors. This study aimed to clarify the characteristics and examine the clinical outcomes of patients who received PD as a long-term dialysis modality. Methods All end-stage renal disease (ESRD) patients who initiated PD at Yonsei University Health System between 1987 and 2000 were screened. Patients who maintained PD for over 15 years were classified as the long-term PD group and those who were treated with PD for less than 5 years were included in the short-term PD group. Demographic and biochemical data and clinical outcomes were compared between the groups. Independent factors associated with long-term PD maintenance were ascertained using multivariate logistic regression analysis. Results Among 1,116 study patients, 87 (7.8%) were included in the long-term group and 293 (26.3%) were included in the short-term group. In the long-term group, the mean patient age at PD initiation was 39.6 ± 11.5 years, 35 patients (40.2%) were male, and the mean PD duration was 205.3 ± 32.7 months. Patients were younger, body weight was lower, the proportion of patients with diabetes or cardiovascular diseases was lower, and the proportion of low to low-average transporters was higher in the long-term group than in the short-term group ( p < 0.001). Multiple logistic regression analysis revealed that age, body mass index (BMI), serum creatinine, type of PD solution, and diabetes were significant independent factors associated with long-term PD maintenance. Conclusion Peritoneal dialysis can be considered as a long-term renal replacement therapy option, especially in non-diabetic, not overweight, and young ESRD patients.

scholarly journals Hepatitis Viruses in Heamodialysis Patients: An Added Insult to Injury?

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kranthi Kosaraju ◽  
Sameer Singh Faujdar ◽  
Aashima Singh ◽  
Ravindra Prabhu
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hemodialysis Patients ◽  
Hepatitis Viruses ◽  
Number Of Patients ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Control Study

Hepatitis B (HBV) and hepatitis C (HCV) viruses are the most important causes of chronic liver disease in patients with end stage renal disease on hemodialysis. The prevalence of hepatitis infection among hemodialysis patients is high and varies between countries and between dialysis units within a single country. This case-control study was undertaken to estimate the occurrence of HBV and HCV infections in patients undergoing hemodialysis in our tertiary care center. All patients receving hemodialysis at our centre with HCV or HBV infection were included in the study. The total number of patients admitted for hemodialysis during the study period was 1710. Among these, 26 patients were positive for HBV, 19 were positive for HCV, and 2 were positive for both HCV and HBV. Mean age of the infected cases in our study was 48.63 years. Mean duration of dialysis for infected cases was 4.8 years while that of the noninfected controls was 3.18 years. The mean dialysis interval was twice a week. Interventions to reduce the occurrence of these infections are of utmost need to reduce the risk of long-term complications among hemodialysis patients.

scholarly journals Pharmacokinetics of Rosiglitazone in Patients with End-Stage Renal Disease

2002 ◽  
Vol 30 (4) ◽  
pp. 391-399 ◽  
Author(s):  
K Thompson-Culkin ◽  
B Zussman ◽  
AK Miller ◽  
MI Freed
Keyword(s):  
End Stage Renal Disease ◽  
Healthy Individuals ◽  
Time Curve ◽  
End Stage Renal Failure ◽  
Concentration Time ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

The pharmacokinetics and tolerability of a single 8-mg oral dose of rosiglitazone, an anti-diabetic agent, were compared in 10 long-term haemodialysis patients and 10 healthy volunteers. Haemodialysis patients received rosiglitazone 4 h after haemodialysis (non-dialysis day) and 3 h before haemodialysis (dialysis day). Haemodialysis did not influence rosiglitazone pharmacokinetics, and dialytic clearance was low (0.10 l/h). The mean area under the concentration-time curve (AUC(0–∞)), the maximum observed plasma concentration ( Cmax) and the half-life for rosiglitazone were similar in haemodialysis patients (non-dialysis day) and healthy individuals (2192 ± 598 ng.h/ml versus 2388 ± 494 ng.h/ml, 338 ± 114 ng/ml versus 373 ± 95 ng/ml, and 3.70 ± 0.75 h versus 3.81 ± 0.86 h, respectively). AUC(0−∞) and Cmax were not markedly influenced by haemodialysis. Rosiglitazone dose adjustments are not warranted in patients with type 2 diabetes with end-stage renal failure on haemodialysis.

scholarly journals Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 30-33
Author(s):  
Dedy Pratama ◽  
Richard Yehuda Limen ◽  
Akhmadu Muradi
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Peak Systolic Velocity ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV >40 cm/s and intraoperative PSV >42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

scholarly journals Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniella Levy Erez ◽  
Irit Krause ◽  
Amit Dagan ◽  
Roxana Cleper ◽  
Yafa Falush ◽  
...  
Keyword(s):  
Survival Rate ◽  
Medical Center ◽  
Significant Risk ◽  
Chronic Dialysis ◽  
Term Survival ◽  
Successful Transplantation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Objective.Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality.Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center.Results.110 patients were enrolled in the study. Mean age was10.7±5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was13.5±5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90%for patients older than 5 years and 61%for younger patients.Conclusions.Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

Arteriovenous Fistulas for Hemodialysis Created using a Long-Term Absorbable Suture: A Safe Solution and a Measure to Minimize Myointimal Hyperplasia

2005 ◽  
Vol 6 (4) ◽  
pp. 171-176 ◽  
Author(s):  
S. Occhionorelli ◽  
D. De Tullio ◽  
D. Pellegrini ◽  
S. Ascanelli ◽  
G. Resta ◽  
...  
Keyword(s):  
Survival Rates ◽  
Absorbable Suture ◽  
Trimethylene Carbonate ◽  
Arteriovenous Fistulas ◽  
Vascular Walls ◽  
Kaplan Meier ◽  
Surgical Suture ◽  
Stage Renal Disease ◽  
End Stage

Background/aims The goal of the therapeutic management of patients affected by end-stage renal disease (ESRD) is to maintain the vascular access (VA) as long as possible. Myointimal hyperplasia development in the vascular walls of arteriovenous fistulas (AVFs) is considered one of the most important factors responsible for procedure failure. These alterations could be linked to hemodynamic changes in the anastomosis and to the presence of the surgical suture itself. We report our preliminary experience, discussing the use and the possible benefits of an absorbable suture in polyglycolide trimethylene carbonate (PTC) in AVF creation. Methods Seventy-four AVFs were created as primary access for hemodialysis (HD), using PTC, over 4 years. Age, gender, ESRD etiology, artery and vein preoperative diameters, AVF survival outcome, and the number of AVFs created per year were recorded. The Kaplan-Meier method was used to analyze AVF survival rates. Results No dehiscences, pseudoaneurysms, or failures in the “critical” period related to PTC absorption were recorded. Kaplan-Meier analysis was used to evaluate AVF survival; 12-month primary AVF survival (74.33%) and AVF failure (25.67%) rates, 9 “early” (8.22%) and 10 “late” failures (13.51%), and a 360-day mean survival were found. Conclusions Our data indicate that PTC, a well known and widely used material for sutures in vascular surgery, is safe and effective in AVF creation. Potential advantages of PTC sutures are represented by a reduced myointimal hyperplasia formation in the AVF vascular walls, prolonging the AVF lifespan and avoiding re-interventions.

Patients on Chronic Peritoneal Dialysis for Ten Years or More in North America

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 127-133 ◽  
Author(s):  
Sanjay Maitra ◽  
John Burkart ◽  
Adrian Fine ◽  
Sarah Prichard ◽  
Judy Bernardini ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Glomerulonephritis ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Common Cause ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Autonomous Hyperparathyroidism

Thirty-six patients on peritoneal dialysis (PD) for more than ten years in six North American centers were analyzed retrospectively. In the six centers, the percentage of patients surviving for more than ten years varied between 0.8% and 7.3%. The study group included 27 females and 9 males aged 38.6 ± 14.2 years [mean ± standard deviation (SD)] at the start of treatment. Of the 36 patients, 28 were Caucasian. The most common cause of end-stage renal disease (ESRD), present in 12 patients, was chronic glomerulonephritis. Only 4 patients had diabetes. At the beginning of the study, 19 patients had hypertension (the most common comorbid condition); 11 had no comorbid conditions at the start. Creatinine clearance at the start was 4.12 ± 3.5 mL per minute, and the mean duration to anuria was 51 ± 25 months. Mean initial body weight was 55 ± 9 kg, and mean body surface area was 1.5 ± 0.2 m2. Serum albumin levels showed an increase from 33.8 ± 3.6 g/L at the start of the study to 38.2 ± 3.9 g/L at the end. Hospitalization rate was low at 0.5 ± 0.3 admissions per patient–year, and duration of hospitalization was 4.8 ± 3.7 days per patient–year. Peritonitis was the most common cause of hospitalization. The mean peritonitis rate was 1 episode every 52 ± 48 patient–months. There were 36 catheter changes in 18 patients; 16 patients had a single PD catheter throughout the period of study. Autonomous hyperparathyroidism was the most common long-term complication. At the end of the study period, 11 patients were still on PD, 9 had died, 5 had been transferred to hemodialysis (HD), 1 was alive with a functioning allograft, and 1 was lost to follow-up. We conclude that patients who survive longer than ten years on PD are most likely to be young Caucasian females, small in body size, who are non diabetic, with few comorbid conditions. These long-term survivors have few hospitalizations, and their peritonitis rate is low. In this group of patients, severe autonomous hyperparathyroidism is the most common long-term complication.

scholarly journals A three years’ experience of Arteriovenous Fistula (AVF) cases in a tertiary care hospital of East Java, Indonesia: a descriptive observational study

2021 ◽  
Vol 1 (2) ◽  
pp. 24-27
Author(s):  
Rafaela Andira Ledyastatin ◽  
Caesario Tri Prasetyo ◽  
Gold Sunday Palm Tampubolon ◽  
Dhihintia Jiwangga
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Tertiary Care Hospital ◽  
Local Population ◽  
Tertiary Care ◽  
Underlying Disease ◽  
Care Hospital ◽  
Arteriovenous Fistulas ◽  
Stage Renal Disease ◽  
End Stage

Introduction: The incidence of end-stage renal disease (ESRD) globally is 700 million people approximately. Patients with ESRD need vascular access for hemodialysis as renal replacement therapy (RRT). Among hemodialysis access, arteriovenous fistula is considered as the most preferred form of vascular access due to its characteristics. This study aimed to to present a descriptive characteristic of arteriovenous fistula creation cases in a tertiary care hospital with a specific view of demographic parameters, fistulas' sites, type of fistulas. Methods: We conducted a descriptive study of single-center in the Department of Thoracic, Cardiac and Vascular Surgery of Dr. Soetomo Academic General Hospital Surabaya, collected data from January 1st, 2017 to December 31st, 2020. All patients who undergo arteriovenous fistula creation considered as a subject in this study. We retrieved the characteristics of the patients, the type of fistula, the site, surgical technique, and underlying disease from patients’ electronic medical data records. Results: A total of 167 patients requiring long-term hemodialysis in our center. Females were dominantly in our study with 56.9% (95). Most of AVFs were created on the left arm. Radiocephalic type of AVF was the most common arteriovenous fistula type found in 111 subjects (66.5%). The highest postoperative successful rate was found in brachiocephalic type in 78.8%, followed by radiocephalic AVF type with 66.7%. The wrist region was favorable in subjects (43.1%). Conclusions: Arteriovenous fistulas for hemodialysis are needed and in our center. Radiocephalic AVFs are the most common type. Further study to learn the different aspects of arteriovenous fistula cases is needed to fulfill queries in the local population.

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