Vascular access use in europe and the united states: results from the dopps

Renal osteodystrophy

https://www.urologic.theclinics.com/article/S0094-0143(99)80020-2/pdf

Laparoscopic live donor nephrectomy

The hemodialysis catheter conundrum: Hate living with them, but can’t live without them

Decellularization methods of porcine kidneys for whole organ engineering using a high-throughput system

Complications associated with vascular accesses account for approximately 30% of hospital admissions for chronic hemodialysis patients. Long-term patency of access was evaluated in 76 patients, without diabetes mellitus, who had been on dialysis for at least 3 years and 41 patients, with diabetes mellitus, who had been on dialysis for over 2 years. Fistulas functioned longer than grafts (58 vs. 22 months, p

Long term survival of vascular accesses in a large chronic hemodialysis population

https://www.ajkd.org/article/S0272-6386(12)80772-4/pdf

Subclavian vein stenosis and thrombosis: a potential serious complication in chronic hemodialysis patients

Fifty-nine chronic hemodialysis patients who had been on dialysis for an average of 77 months underwent bone biopsies and the pathologic findings were correlated with biochemical and demographic data. All but two had evidence of renal osteodystrophy, 23 with osteitis fibrosa (OF), 19 with osteomalacia and/or adynamic disease (OM/AD), and 15 with mixed osteodystrophy (MOD). Patients in each group were similar with regard to age, sex distribution, duration of dialysis, unstimulated serum aluminum, calcium and phosphorus. Patients with osteitis fibrosa (OF) had statistically higher DFO stimulated aluminum, alkaline phosphatase and PTHC levels than the other two groups although there was marked individual variation. The bone biopsies were also evaluated for the amount of aluminum deposited in the osteoid seam. All 23 of the patients with OF and 11 of the 15 patients with MOD had no, mild, or minimal aluminum deposition but 12 of the 19 patients with OM/AD had moderate to marked aluminum deposition. Patients with minimal to mild aluminum deposition were similar in age, duration of dialysis, sex distribution, unstimulated and DFO stimulated aluminum levels, calcium, phosphorus, alkaline phosphatase to those with moderate to marked deposition but had significantly higher parathormone levels. All patients had been treated in a similar fashion regarding diet, oral phosphate binders and vitamin D; therefore, the observed differences in bone pathology were not readily explicable. However, patients who were found to have osteitis fibrosa and those with minimal to mild aluminum deposition had significantly higher parathormone levels when compared with patients in the other groups at the inception of dialysis.

The clinical spectrum of renal osteodystrophy in 57 chronic hemodialysis patients: a correlation between biochemical parameters and bone pathology findings.

A prospective study of 70 patients admitted to the Rhode Island Hospital and treated for glutethimide intoxication conservatively, without hemodialysis, was undertaken. The diagnosis was confirmed in each case by elevated blood glutethimide levels; mixed intoxications with barbiturates were excluded by negative blood levels. Although only 1 patient died, 31 were unresponsive on admission and had complicated clinical courses associated with significant morbidity. Blood and cerebrospinal fluid glutethimide levels obtained on admission and subsequently were poorly correlated with duration of coma or morbidity. We conclude that (1) plasma glutethimide values are needed to confirm the diagnosis but are of little prognostic significance; (2) conservative treatment is associated with a very low mortality, although frequent and significant morbidity does occur among comatose patients; and (3) hemodialysis would appear to be needed rarely in the treatment of patients with glutethimide intoxication.

Glutethimide Intoxication: A Prospective Study of 70 Patients Treated Conservatively Without Hemodialysis

The annual mortality rate among patients receiving long-term hemodialysis has been rising over the past decade. The prevalences of known risk factors such as older age, male sex, duration of dialysis, presence of diabetes, coronary artery disease, or hypertension do not seem to have changed during this time. However, evidence suggests that an increased body aluminum level may have an adverse effect on survival even in the absence of overt aluminum toxic reaction. Therefore, we evaluated the correlation between serum aluminum levels and mortality in 10 646 patients undergoing long-term hemodialysis. Mortallities were 18% higher for patients with serum aluminum levels between 1520 and 2220 nmol/L and progressively increased to 60% higher for patients with aluminum levels above 7410 nmol/L. Serum aluminum level was an important predictor of survival even after other known risk factors had been controlled. These data strongly suggest that patients undergoing long-term hemodialysis should have periodic surveillance of the serum aluminum levels, and in those patients who have plasma levels of 1520 to 2220 nmol/L or higher, one should seriously consider discontinuing aluminum salts and giving therapy to decrease body aluminum level if it is found to be increased. ( Arch Intern Med . 1991;151:319-322)

Joseph A. Chazan

Papers

Long term survival of vascular accesses in a large chronic hemodialysis population

Subclavian vein stenosis and thrombosis: a potential serious complication in chronic hemodialysis patients

The clinical spectrum of renal osteodystrophy in 57 chronic hemodialysis patients: a correlation between biochemical parameters and bone pathology findings.

Glutethimide Intoxication: A Prospective Study of 70 Patients Treated Conservatively Without Hemodialysis

Increased serum aluminum. An independent risk factor for mortality in patients undergoing long-term hemodialysis.