Vascular access hemorrhages contribute to deaths among hemodialysis patients

Ellingson, Katherine; Palekar, Rakhee; Lucero, Cynthia; Kurkjian, Katherine M.; Chai, Shua J.; Schlossberg, Dana S.; Vincenti, Donna M.; Fink, Jeffrey C.; Davies-Cole, John; Magri, Julie M.; Arduino, Matthew J.; Patel, Priti R.

doi:10.1038/ki.2012.185

Cited by 69 publications

(74 citation statements)

References 12 publications

(15 reference statements)

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“…Although rates of colonization with multidrugresistant organisms are unknown in patients undergoing home HD, it is plausible that less frequent contact with health care facilities would result in less frequent colonization and infection. Beyond potential differences in risk for nosocomial infection, HD in the home setting may lead to higher risk for rare but potentially catastrophic AV access-related adverse events (26,27).…”

Section: Discussionmentioning

confidence: 99%

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Rivara

Soohoo

Streja

et al. 2016

Clinical Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 99%

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Rivara

Soohoo

Streja

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Furthermore, transplantation has the added benefit of avoiding the mortality risk associated with vascular access 20 and dialysis treatment-related complications. 21 Kidney transplant recipients face an increased risk of surgical complications, infections, and acute rejection, which may be reflected in an increased risk of early hospital readmission 22 and length of stay. Accordingly, a lower early rate of hospital admission was observed for IHHD patients.…”

Section: Discussionmentioning

confidence: 99%

Survival and Hospitalization for Intensive Home Hemodialysis Compared with Kidney Transplantation

Tennankore

Kim

Baer

et al. 2014

Journal of the American Society of Nephrology

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Canadian patients receiving intensive home hemodialysis (IHHD; $16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States, but a comparison with Canadian kidney transplant recipients has not been conducted. We conducted a retrospective cohort study of consecutive, adult IHHD patients and kidney transplant recipients between 2000 and 2011 at a large Canadian tertiary care center. The primary outcome was time-to-treatment failure or death for IHHD patients compared with expanded criteria, standard criteria, and living donor recipients, and secondary outcomes included hospitalization rate. Treatment failure was defined as a permanent switch to an alternative dialysis modality for IHHD patients, and graft failure for transplant recipients. The cohort comprised 173 IHHD patients and 202 expanded criteria, 642 standard criteria, and 673 living donor recipients. There were 285 events in the primary analysis. Transplant recipients had a reduced risk of treatment failure/death compared with IHHD patients, with relative hazards of 0.45 (95% confidence interval [95% CI], 0.31 to 0.67) for living donor recipients, 0.39 (95% CI, 0.26 to 0.59) for standard criteria donor recipients, and 0.42 (95% CI, 0.26 to 0.67) for expanded criteria donor recipients. IHHD patients had a lower hospitalization rate in the first year of treatment compared with standard criteria donor recipients and in the first 3 months of treatment compared with living donor and expanded criteria donor recipients. In this cohort, kidney transplantation was associated with superior treatment and patient survival, but higher early rates of hospitalization, compared with IHHD.

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“…Hemorrhage from fistula has been reported in the in-center HD population, 38,39 but the incidence of this occurring among home patients is unknown. All patients should be instructed to apply pressure to their site in the event of bleeding and to call for emergency assistance (e.g., 911, 991, 999, 112, or 000 as appropriate).…”

Section: Fistula Hemorrhagementioning

confidence: 99%

The care and keeping of vascular access for home hemodialysis patients

Faratro

Jeffries

Nesrallah

et al. 2015

Hemodialysis International

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Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation. Technical aspects of central venous catheter care, as well as a guide to troubleshooting catheter complications, are covered in detail. Monitoring for access-related complications of stenosis, infection, and thrombosis is a key part of every home HD program. Key performance and quality indicators are important mechanisms to ensure patient safety in home HD and should be used during routine clinic visits.

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Vascular access hemorrhages contribute to deaths among hemodialysis patients

Cited by 69 publications

References 12 publications

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

Survival and Hospitalization for Intensive Home Hemodialysis Compared with Kidney Transplantation

The care and keeping of vascular access for home hemodialysis patients

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