Bacterial Load Associated With Tunneled Dialysis Catheters in Symptom-Free Hemodialysis Patients.

I am not surprised by the finding that Prolonged duration and use of the catheter is significant in terms of bacterial load. I agree that the use of TDC as vascular access in renal replacement therapy should be avoided as much as possible.





Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department-based Study.



Contrast Nephropathy appears to be a disease that does not exist according to some (Glenn Chertow, Stanford)) . However, he hedges when eGFR is CKD stage 4 or worse. This paper confirms this in my mind. There is a risk at lower eGFRs, especially < 30 mk/min/1.73m2. Also, ony one contrast agent was used , nonionized iodinated

contrast media (iohexol, Omnipaque; GE Healthcare).



Outcomes of Thrombolytic Therapy of Tunnelled Hemodialysis Catheter Dysfunction.



This study deals with partial occlusion of a catheter lumen limiting DBF to < 250 ml/min on 2 consecutive treatments/ I have not practiced for 6.5 years. But we had such issues when I did.
I never achieved an inter-treatment duration of 9 months in our catheters that did not provide at least 300 ml/min (our threshold was higher since we used larger bore catheters). However, in Catheter dependent patients, I managed to keep some catheters going for years by instilling Alteplase on a schedule every 2-4 weeks in response to decreasing blood flow to the dialyzer.. I never did a cost analysis whether this was effective or not. buy thrombolytic use every few weeks must cost less than changing the catheter over a guidewire. In fact, I wrote an opinion piece in 201.. The basic premise was that a Pre-pump pressure more neg than 250 mm Hg not delivering a BFR of 300 ml/min was "dysfunctional". Oddly enough, I never saw anyone (LDOs) or CMS pick up on this. I think at that time there was money to be made by using tPA. [Pardon me for being Jaded)

Besarab A, Pandey R. Catheter Management in Hemodialysis Patients: Delivering Adequate Flow. Clin J Am Soc Nephrol. 2011;6(1):227-34. Epub 2010 Nov 29



Repeated Endovascular Interventions Are Worthwhile, Even After Thrombosis, to Maintain Long-Term Use of Autogenous Dialysis Fistulas.



Must compliment the Danbury CN group on having such good patency over a period of 3 or more years. Looked at interventions only after access had matured (with or without help). Interestingly the abandoned group had less Coronary artery disease (by Fisher exact test, my calculation, instead of Xi square) . Importantly, there was a high incidence of RC AVF. Table one is not presented properly. The percentages shown are as percent of total participants rather than as a percentage of the category, functional vs Abandoned . The comparisons made are between categories. Having a pre-dialysis intervention trended toward statistical significance for greater number of interventions (p 0.061), suggested that we are looking at the effect of maturation assistance as a factor. I am not sure how obese the population was. A cut off for BMI of 25 is OK but I would have liked to see the actual numbers. Perhaps it is not obesity that is the factor but malnutrition.



Anatole