Michael Allon

..Dialysis grafts fail due to recurrent stenosis and thrombosis. Vasoactive and prothrombotic substances affecting intimal hyperplasia or thrombosis may modify graft outcomes...

..The development and widespread adoption of effective approaches to the treatment and prophylaxis of catheter-related bacteremia will dramatically reduce the morbidity and economic burden associated with this complication...

..In conclusion, routine application of an antibiotic lock protocol may reduce substantially the need for routine catheter replacement in hemodialysis patients with catheter-related bacteremia...

..Few prospective studies have examined the clinical consequences of infection-related hospitalizations in haemodialysis patients or the risk factors predictive of clinical outcomes...

..However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality...

..The following position paper outlines the financial barriers to improved vascular access outcomes and our proposals for a future CMS demonstration project...

..76%; P<.001). CLS dramatically reduces the frequency of catheter-related bacteremia among patients undergoing hemodialysis, although there is an increased requirement for thrombolytic interventions to maintain catheter patency...

..The goal of this review is to provide an update on the current status of vascular access management...

..Careful clinical judgment should optimize vascular access outcomes and minimize prolonged catheter dependence among hemodialysis patients...

..The authors compared the clinical presentation, complications, and outcomes of infections of thigh and upper extremity grafts...

..The pathogenesis of AVF nonmaturation may be related to pre-existing vascular pathologic states: medial fibrosis or microcalcification may limit arterial dilation, and intimal hyperplasia may cause stenosis...

..Thus, routine surveillance for graft stenosis, with preemptive angioplasty, cannot be recommended for reduction of graft thrombosis. Future research should be directed at pharmacologic interventions to prevent graft stenosis...

..The aim of this study was to compare the outcomes of three upper arm access types: brachiocephalic fistulas, transposed brachiobasilic fistulas, and grafts...

..However, the frequency of access-related, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas...

..1 versus 5.2%; P = 0.07). In conclusion, placement of thigh grafts should be considered a viable option among hemodialysis patients who have exhausted all options for a permanent vascular access in both upper extremities...

..Finally, female sex, residual stenosis, and high postprocedure access pressure ratio are each predictive of shorter access patency after elective angioplasty...

..However, once the access is usable for dialysis, fistulas have superior cumulative patency than do grafts and require fewer interventions to maintain patency...

..CRB may be treated by instilling an antibiotic lock into the catheter lumen in conjunction with systemic antibiotics. The efficacy of this approach in Enterococcus bacteremia is unknown...

..In conclusion, use of aspirin associates with a trend toward longer primary unassisted patency of newly placed hemodialysis grafts similar to that observed for ERDP/ASA...

..However, the effect of this change on catheter patency is unknown. We compared catheter patency between two heparin lock solutions: 1000 versus 5000 units/ml...

..Arteriovenous (AV) grafts in haemodialysis patients usually fail due to thrombosis or infection. There is limited information on whether graft outcomes in HIV-positive haemodialysis patients differ from those in HIV-negative controls...

..004). Symptomatic stenosis occurs much earlier at the venous anastomosis compared with other vascular sites. Moreover, preexisting ipsilateral internal jugular dialysis catheters more than double the risk of central vein stenosis...

..Surgical salvage of a thrombosed AV graft after an unsuccessful percutaneous intervention is rarely feasible. Most patients have a severe anatomic lesion that cannot be repaired, and require creation of a new vascular access...

..In patients with an access emergency, implantation of a polyurethane graft incurs a tradeoff between earlier cannulation and a higher risk of infection...

..In the interim, this patient population developed a high frequency of catheter-related bacteremia...

..The goal of the present study was to evaluate whether pelvic artery calcifications are associated with technical failure of arteriovenous thigh grafts in haemodialysis patients...

..Thus, heparin coating of catheters may reduce thrombosis and infection. This study evaluated whether heparin-coated hemodialysis catheters have fewer infections or greater cumulative survival than noncoated catheters...

..Unfortunately, few data exist to guide dose adjustment in patients with decreased kidney function. Here, we determine the degree of warfarin dose reduction associated with kidney impairment and make recommendations for warfarin dosing...

..The efficacy of this therapy is uncertain in Staphylococcus aureus bacteremia...

..However, long-term symptomatic relief can be achieved with multiple subsequent interventions in many patients...

..50%). Graft age was not associated with the likelihood of graft thrombosis (p = 0.12). In contrast to the prevailing wisdom, arterial aneurysms are associated with improved graft survival...

..CONCLUSION: Needle infiltration of fistulae is more common in older patients and with new fistulae. These infiltrations result in numerous procedures, as well as prolongation of catheter dependence for more than 3 months...

..25 cm or greater on preoperative sonographic mapping. It is not established, however, whether a vein diameter before or after application of a tourniquet should be used in determining suitability for creation of a forearm fistula...

..Diminished renal function may have implications for a larger proportion of warfarin users than previously estimated...

..The goal of this retrospective study was to compare the clinical outcomes of catheter-related candidemia managed with two different strategies: Guidewire exchange of the infected catheter versus removal with delayed replacement...

..Thus, the overall success rate in an individual dialysis programme will depend on the relative frequencies of different bacterial pathogens...

..To compare various objective ultrasonographic (US) criteria for native arteriovenous fistula (AVF) maturation with subsequent fistula outcomes and clinical evaluation by experienced dialysis nurses...

..However, CRB is likely to be more severe in HIV-positive patients, as judged from the greater likelihood of polymicrobial infection and of hospitalization...

..Catheters may cause central vein stenosis, which can adversely affect vascular access outcomes. We compared vascular access outcomes in patients with a history of ipsilateral and contralateral dialysis catheters...

..If nephrologists are to take their appropriate place as leaders of the care delivery team, nephrology fellowships must be restructured with appropriate emphasis placed on the comprehensive care of ESRD and CKD patients...

..Emphasis on early referral of patients with chronic kidney disease without diabetes to nephrologists may increase fistula use among incident hemodialysis patients...

..However, the primary fistula patency is fairly short-lived, and the fistulas require repeated interventions to achieve long-term survival...

..When the infecting organism is S. epidermidis, attempted salvage with systemic antibiotics and an antibiotic lock is reasonable. However, prompt catheter removal is indicated when the pathogen is S. aureus...

..In recent observational studies, overall mortality was similar in men and women and higher in small patients. The effect of dialysis dose in each of these subgroups has not been tested in a clinical trial...

..The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction...

..However, differences among dialysis units are likely to persist because of differences in gender, race, and co-morbidity mix of the patient population...

..CONCLUSIONS: These data suggest that fistulas are less likely to be useable for dialysis in women than in men, despite routine preoperative mapping and frequent interventions undertaken to salvage immature fistulas...

..These disparities in the frequency of failure to mature may be due in part to marginal vessels in the high-risk groups and should be reduced by routine preoperative vascular mapping...

..Thus, the loss of NO signaling and the loss of endothelial integrity caused by needle jet turbulence may contribute to the cascade of events leading to IH formation during hemodialysis...

..An ipsilateral lower extremity deep vein thrombosis occurs commonly after placement of a femoral dialysis catheter, but does not preclude continued catheter use...

..The goal of this study was to quantify infections in such patients, to characterize their clinical presentations, and to evaluate factors determining need for hospitalization...

..pRCF has a lower non-maturation rate than that of a dRCF, and a comparable cumulative survival once it is used successfully for dialysis...

..It can result in significant cost savings without exposing the patients to an increased risk of complications...

..Moreover, this management approach offers clinical advantages over routine catheter exchange...

..This strategy may increase catheter use when these patients start dialysis therapy. We compared the outcomes of patients whose grafts were placed before and after dialysis therapy initiation...

..Real-time ultrasound-guided renal biopsy is the preferred technique...

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..73 m(2). In conclusion, age is a major effect modifier among patients with an eGFR of <60 ml/min per 1.73 m(2), challenging us to move beyond a uniform stage-based approach to managing CKD...

..Prolonged fasting may provoke hyperkalemia, which can be prevented by administration of intravenous dextrose...

..The present case highlights key physiologic mechanisms in the development of hyperkalemia and provides an outline for emergent treatment. In this context, we discuss specific mechanisms of action of available treatments of hyperkalemia...

..29). In conclusion, thrombectomy within 60 days of graft creation is associated with poor primary and cumulative graft patency, and may not be worthwhile...

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..Small, inconclusive trials have suggested that antiplatelet agents may reduce thrombosis of new fistulas...

..The clinical utility of these risk categories in increasing rates of permanent accesses requires further clinical evaluation...

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..CONCLUSIONS: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane...

..The fish oil inhibition of stenosis in hemodialysis grafts (FISH) study evaluates the efficacy of fish oil in improving HD graft patency...

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..The possibility of similar (albeit smaller) biases should be considered when analyzing observational data sets relating mortality to achieved dose of dialysis...

..The applicant will assist the trainees in acquiring the conceptual skills, research experience, and motivation required to pursue a successful career in Academic Nephrology. ..

..The primary endpoint will be fistula thrombosis within 6 weeks, and the secondary endpoint will be the ability to use the fistula successfully for dialysis within 6 months. ..

..Unfortunately, about 50% of fistulas don't mature, and therefore cannot be used for dialysis. The goal of this study is to identify abnormalities of the arteries and veins that predict whether a fistula will mature. ..