Background:There are many factors that can affect dialysis adequacy; such as the type of vascular access, filter type, device used, and the dose, and rout of erythropoietin stimulation agents (ESA) used. The aim of this study was investigating factors affecting Hemodialysis adequacy in cohort of Iranian patient with end stage renal disease (ESRD).Methods:This is a cross-sectional study conducted on 133 Hemodialysis patients referred to two dialysis units in Sistan-Baluchistan province in the cities of Zabol and Iranshahr, Iran. We have looked at, (the effects of the type of vascular access, the filter type, the device used, and the dose, route of delivery, and the type of ESA used) on Hemodialysis adequacy. Dialysis adequacy was calculated using kt/v formula, two-part information questionnaire including demographic data which also including access type, filter type, device used for hemodialysis (HD), type of Eprex injection, route of administration, blood groups and hemoglobin response to ESA were utilized. The data was analyzed using the SPSS v16 statistical software. Descriptive statistical methods, Mann-Whitney statistical test, and multiple regressions were used when applicable.Results:The range of calculated dialysis adequacy is 0.28 to 2.39 (units of adequacy of dialysis). 76.7% of patients are being dialyzed via AVF and 23.3% of patients used central venous catheters (CVC). There was no statistical significant difference between dialysis adequacy, vascular access type, device used for HD (Fresenius and B. Braun), and the filter used for HD (p> 0.05). However, a significant difference was observed between the adequacy of dialysis and Eprex injection and patients’ time of dialysis (p <0.05).Conclusion:Subcutaneous ESA (Eprex) injection and dialysis shift (being dialyzed in the morning) can have positive impact on dialysis adequacy. Patients should be educated on the facts that the type of device used for HD and the vascular access used has no significant effects on dialysis adequacy.

Background and Objectives: Access monitoring and pre-emptive angioplasty is known to decrease the incidence of AVF/AVG thrombosis. The effect on increase the longevity and functionality of Arterial-Venous access (AV access) in end-stage renal disease (ESRD) patients is not settled. Thrombosis is the leading cause of vascular access complications and is almost always associated with the presence of stenosis. Percutaneous transluminal angioplasty (PTA) is an accepted treatment of stenotic lesions in AV access (NKF 2001). The purpose of this study is to assess the effect of follow up of ESRD patients in the dialysis access center with preemptive angioplasty on access thrombosis.Design, Setting, Participants, & Measurements: This is a single center observational interventional study extended over 9 years (Jan 1, 2006 to Dec 31, 2014 at the Dialysis Access Center of Pittsburgh, PA. The study is divided into 2 periods, period A (from Jan 2006 to December 2009), where follow up program was not in place. Period B extends from (January 1, 2011 to December 31, 2014). In this period, a follow up of patients with preemptive angioplasty of AV access has been implemented. We decided not to include 2010 as the program is implemented at the end of that year and including this year might skewed the data. All patients with ESRD on HD are seen in the Dialysis access center of Pittsburgh for access monitoring and interventional PTA if deemed necessary. Patients' data were abstracted from the electronic medical records. The study is approved by the IRB of Lifeline corp.Results: During period A; a total of 4139 encounters with a mean of 1034, (1653 angioplasties with mean of 413/year, 375 angiogram, mean 94/year, and 303 thrombectomies of AVF/AVG with a mean 76/year) were carried out. Thrombectomies constituted (7.3%) of the total procedures performed. Table 1 showed the mean distributions of AVG, AVF, and tunneled dialysis catheters (TDC) frequencies compared to national average in periods A & B.In period B, a total of 6229 encounters with mean of 1557 encounter/year were performed, (3202 angioplasties, mean 801/year, 950 angiograms, mean 238/year, and 196 thrombectomies, mean 42/year) were done. Thrombectomies were decreased almost 2 folds in this period (7.3% to 3.15%).The percentage of patients being dialyzed via TDC decreased in period B from 31.895% to 17.38%. The numbers of thrombectomies have also been decreased from average 76 to 42 /year (7.3% to 3.15%).After implementing the program, as illustrated in period B, compared to the national average, the frequency of thrombectomies (3.15% vs. 9.6%) and TDC use (17.38% vs. 18%), have showed significant improvement. Meanwhile, the number of PTA has doubled from an average of (413 to 801/year) between the 2 periods. Our fistula rate has gone up from 48.7% to 66.2% between the 2 periods. Mild increase of the AVG use (12.07% to 18.07%) has also been observed. However, the use of TDC has decreased from (31.42% to 17.38%). These results are consistent with the motto of (fistula...

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Case Report GJUN (2019) 2:13 Two Options the sweetest among them is bitter: Fournier-gangrene associated with sodium-glucose co-transporter 2-inhibitors The authors discuss a case of sodium-glucose co-transporter 2 inhibitor associated with Fournier-gangrene in a patient with type-2 diabetes millets. The patient had extensive surgical intervention and skin graft but succumbed to her disease.

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Objectives: To evaluate the usefulness of low-dose computed tomography after Extracorporeal Shock Wave Lithotripsy (ESWL) for urolithiasis. Methods:We investigated 103 subjects with urolithiasis who were treated with ESWL. In each case, preoperative plain abdominal films of the Kidney, Ureter and Bladder (KUB) and Standard Computed Tomography (SDCT) and postoperative KUB and Low-Dose Computed Tomography (LDCT) were performed. We compared the Dose Length Product (DLP) and Effective Dose (ED) of SDCT and LDCT. We evaluated any residual calculus by performing postoperative KUB and LDCT, calculating their respective rates of complete fracture, and comparing the performance of both examinations. Results:The mean DLP and ED were 409 mGy and 6.1 mSv with SDCT, and 103 mGy and 1.5 mSv with LDCT; the dose reduction rate was nearly 75% in both DLP and ED (P < 0.001). The mean ED of KUB was 1.3 mSv, which was similar in dose to LDCT. The accuracy of LDCT was 100%, with no false positives or false negatives. On the other hand, the positive predictive rate of KUB was 90.4%, whereas the negative predictive rate was 75.6%, and the accuracy was 78.6% (P < 0.001). Conclusion:The exposure dose of LDCT was reduced by 75% compared with that of SDCT. Our findings suggest that LDCT is likely to be a useful method to assess urinary calculi following ESWL.

The patient is 72-year-old Caucasian male with history of type-2 diabetes mellitus, coronary artery disease with drug eluting stent, and congestive heart failure with ejection fracture of 40% was admitted to hospital with shortness of breath at rest. The patient noticed swelling of the legs for 4 weeks despite salt restriction and diuretics. His medications include Humalog (75/25) 20 units QD, frusemide 40 mg BID, metolazone 2.5 mg QD, spironolactone 12.5 mg QD, carvedilol 12.5 mg BID, Ramipril 10 mg QD, atorvastatin 40 mg QD, clopidogrel 75 mg QD, and aspirin 81 mg QD. His blood pressure was 100/60 mmHg, pulse 102 beats/ min, The patient had marked jugular venous distention, crackles at the lung bases, an S3 gallop, positive hepato-jugular reflux, and pitting edema up to the knees. His laboratory investigation showed sodium of 134 mEq/L, potassium of 3.8 mEq/L, chloride 90 mEq/L, bicarbonate 28 mEq/L, blood urea nitrogen 46 mg/L, creatinine 1.8 mg/L, with an estimated GFR of <60 mL/minute, and glucose of 100 mg/L. His HgbA1C was 7%. His urinalysis was significant for 2+ proteinuria. EKG showed tachycardia with nonspecific St and T wave changes, His weight was 98 kg.The patient developed type-2 cardio-renal syndrome and his diuretics, nesiritide, and nitroglycerine were stopped, and he was started on renal replacement therapy in the form of Continuous Veno-Venous Hemodiafiltration (CVVHDF) to improve both fluid overload and worsening renal function. Case DiscussionClinically, heart failure is classified into two major types based on the functional status of the heart: heart failure with preserved

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