Barriers to adequate delivery of hemodialysis

Sehgal, AR; Snow, Richard; Singer, Mendel E.; Amini, SB; Pb, DeOreo; Cebul, Randall D.

doi:10.1053/ajkd.1998.v31.pm9531174

Cited by 89 publications

(59 citation statements)

References 24 publications

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“…Factors that contribute to reduced physical activity among dialysis patients include uremic myopathy and anemia of chronic disease (19). Better dialysis adequacy, conferred by AVF use, may lead to greater uremia reduction and reduced anemia compared with CVC use (20,21). Recirculation, reduced blood flow, and catheter thrombosis may reduce dialysis adequacy among CVC patients, whereas anemia and EPO resistance may contribute to decreased energy and exercise capacity (22,23).…”

Section: Discussionmentioning

confidence: 99%

Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

Wasse¹,

Kutner²,

Zhang³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background: Although the arteriovenous fistula (AVF) is the recommended form of vascular access for patients with ESRD, its impact on patient perception of health status, quality of life (QOL), or satisfaction is unknown.Design, setting, participants, and measurements: This study compared patient-reported health status and QOL scores and vascular access type among a national random sample of 1563 patients at dialysis initiation and day 60 of ESRD during 1996 to 1997. Patients were stratified into five categories: AVF at first dialysis and day 60 of ESRD, arteriovenous graft (AVG) at first dialysis and day 60, central venous catheter (CVC) at first dialysis and AVF at day 60, CVC at first dialysis and AVG at day 60, and CVC at first dialysis and day 60.Results: Ten percent (n ‫؍‬ 154) of patients had an AVF, 21% (n ‫؍‬ 326) had an AVG, and 69% (n ‫؍‬ 1083) had a CVC at dialysis initiation; those who were most likely to use an AVF were white and male. After statistical adjustment, patients with persistent AVF use reported greater physical activity and energy, better emotional and social well-being, fewer symptoms, less effect of dialysis and burden of kidney disease, and better sleep compared with patients with persistent CVC use, whereas measures such as cognitive and sexual function did not differ by access type.Conclusions: Compared with persistent CVC use, early persistent AVF use is associated with the perception of improved health status and QOL among patients with ESRD. Future longitudinal studies may help to clarify further the association between QOL and vascular access.

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Section: Discussionmentioning

confidence: 99%

Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

Wasse¹,

Kutner²,

Zhang³

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…It has been reported that a low dialysis prescription is a strong predictor of inadequate dialysis dose. 18 Furthermore, based on analysis of data from the HEMO Study, the 90% confidence interval for the spKt/V of 1.3 was 0.10 units and for URR was 4%. 17 Nephrologists using the K/DOQI guidelines would therefore be advised to target a higher Kt/V or URR, as the case may be, to achieve the minimum target, as indicated earlier.…”

Section: Overview Of Kidney Disease Outcomes Quality Initiative Guidementioning

confidence: 99%

Dose of dialysis: Key lessons from major observational studies and clinical trials

Saran

Canaud

Depner

et al. 2004

American Journal of Kidney Diseases

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“…They occur in 30 to 40% of patients, can occur within 24 hours after insertion or after prolonged continuous successful usage (18), and can provide a substrate for bacterial growth (19). A study of 721 HD patients revealed that clot formation was one of four parameters, significantly (P Ͻ 0.001) and independently related to inadequate dialysis dose delivery (20).…”

Section: Defining Access Dysfunctionmentioning

confidence: 99%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

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SummaryOver 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of endstage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.

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Barriers to adequate delivery of hemodialysis

Cited by 89 publications

References 24 publications

Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

Dose of dialysis: Key lessons from major observational studies and clinical trials

Catheter Management in Hemodialysis Patients

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