Transposed brachiobasilic fistulas provide cumulative patency equivalent to upper arm grafts and brachiocephalic fistulas. They are less likely to thrombose and become infected than upper arm grafts. Compared with brachiocephalic fistula, they are more likely to mature but are at increased risk of thrombosis after maturation. Transposed brachiobasilic fistulas should be considered before placing an upper arm graft for patients that cannot achieve a functional brachiocephalic fistula.

Interstitial nephritis due to BK polyomavirus occurred in 2.5% of patients receiving renal transplants at our center since 1996. Polyomavirus infection can cause transplant dysfunction and graft loss, but progression of the infection can frequently be abrogated with alterations in immunosuppressive therapy. Both renal biopsy and EM of urine samples are useful in the diagnosis and monitoring of polyomavirus infections.

Abstract. Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35% annual rate. . The first infection-related hospitalization was related to the vascular access in 21% of the cases, and non-access-related in 79%. Catheters were present in 32% of all study patients admitted with access-related infection, even though catheters represented only 7.6% of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of accessrelated, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.Infection is the second most common cause of death (after cardiovascular disease) among hemodialysis patients (1,2) and is a frequent cause of hospitalization (3). Mortality due to sepsis occurs about 250-fold more commonly among hemodialysis patients than among the general population (4). There is limited literature analyzing the type and frequency of serious infections among hemodialysis patients. Most reported studies are retrospective and have identified diabetes, older age, comorbidity, hypoalbuminemia, and the use of a temporary dialysis catheter as the major, independent risk factors for serious infections (1,3-7).Observational studies have suggested that a higher dialysis dose and use of a high-flux membrane may each decrease the likelihood of infectious events (1,8), but these potential benefits have not been evaluated in randomized studies. The HEMO Study was a large, prospective, multicenter study in which chronic hemodialysis patients were randomized to receive either standard-dose or high-dose dialysis and to use high-flux or low-flux dialyzers, and clinical outcomes tracked prospectively (9). A predefined secondary aim of the study was to determine whether dialysis dose (clearance of small molecules) or membrane flux (clearance of larger molecules) affected infectionrelated deaths or hospitalizations.The present report (1) evaluates the frequency and specific etiologies of infection-related deaths and hospitalizations in this defined patient population (2), assesses whether a higher Kt/V or high-flux dialyzer decreased the likelihood of serious infections, and (3) determines what other baseline clinical factors affect infect...

We conclude that AHR, when diagnosed early and treated aggressively with PP and IVIG, carries a short-term prognosis that is similar to ACR.

In our experience the HeRO device has performed comparably to standard AVGs and has proven superior to TDCs in terms of patency, intervention, and infection rates when compared to the peer-reviewed literature. As an alternative to catheter dependence as a means for hemodialysis access, this graft could reduce the morbidity and mortality associated with TDCs and have a profound impact on the costs associated with catheter related infections and interventions.

In summary, infection-related hospitalizations are associated with substantial morbidity. Patient age, serum albumin and infectious disease category are independently correlated with the hospitalization outcome, and can be used to estimate the likelihood of serious outcomes at the time of hospital admission.

No abstract

Infections and specifically infectious complications of vascular access remain a major cause of morbidity and mortality in the hemodialysis population. Primary arteriovenous fistulas have the lowest rates of infections and are the access of choice whenever vascular anatomy allows. The dialysis outcomes quality initiative (DOQI) guidelines have thus stressed the need for increasing the utilization of arteriovenous fistulas. Unfortunately, comorbid disease processes and late referrals for vascular access have maintained our dependence on synthetic grafts and indwelling catheters. Indwelling catheters, in particular, have the highest rate of infection and are often associated with more serious metastatic complications. Appropriate antibiotics along with aggressive surgical debridement remain crucial in bacteremia occurring in arteriovenous fistulas or synthetic grafts (polytetrafluoroethylene). Catheter related bacteremia necessitates catheter removal with either guidewire exchange or replacement after a period of antibiotic therapy. Measures to increase our utilization of primary fistulas whenever possible will lower the risk of these complications in our patients.