Search

End-stage kidney disease patients who are candidates for surgical arteriovenous fistula creation commonly experience obstacles to a functional surgical arteriovenous fistula, including protracted wait time for creation, poor maturation, and surgical arteriovenous fistula dysfunction that can result in significant patient morbidity. The recent approval of two endovascular devices designed to create a percutaneous arteriovenous fistula enables arteriovenous fistula creation to be placed in the hands of interventionalists, thereby increasing the number of arteriovenous fistula providers, reducing wait times, and allowing the patient to avoid surgery. Moreover, current studies demonstrate that patients with percutaneous arteriovenous fistula experience improved time to arteriovenous fistula maturation. Yet, in order to realize the potential advantages of percutaneous arteriovenous fistula creation within our hemodialysis patient population, it is critical to select appropriate patients, ensure adequate patient and dialysis unit education, and provide sufficient instruction in percutaneous arteriovenous fistula cannulation and monitoring. In this White Paper by the American Society of Diagnostic and Interventional Nephrology, experts in interventional nephrology, surgery, and interventional radiology convened and provide recommendations on the aforementioned elements that are fundamental to a functional percutaneous arteriovenous fistula.

Interventional nephrologists and radiologists place peritoneal dialysis catheters using the percutaneous fluoroscopic technique in both the inpatient and outpatient setting. Nephrologists caring for such patients may have to diagnose and manage the complications resulting from these procedures. Abdominal pain can occur following peritoneal dialysis catheter placement when the local and systemic analgesia wears off. However, abdominal pain with hypotension is suggestive of a serious complication. Bleeding into the abdomen and perforation of the colon or bladder should be considered in the differential diagnosis. In the case reported here, the peritoneogram showed contrast in the bowel, and correct interpretation by the interventionist would have prevented this complication. The characteristic pattern of peritoneogram images in this case will guide interventionists to avoid this complication, and the discussion of the differential diagnosis and management will assist nephrologists in taking care of such patients., (Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: The optimal method for placement of peritoneal dialysis catheters (PDC) is unclear. The objective of this study was to compare the outcomes of laparoscopic and open surgical placement of PDC., Materials and Methods: Patients who underwent laparoscopic (LPD) and open (OPD) surgical placement of PDC between 2007 and 2011 were identified from the American College of Surgeons National Surgical Quality Initiative Project (NSQIP) dataset using current procedural terminology (CPT) and international classification of diseases 9th revision (ICD-9) codes. Perioperative outcomes were compared using Fisher's exact test for categorical variables, Student's t-test and Gamma regression were used for continuous variables. Catheter function was not reported in the dataset., Results: There were 1,560 PDC procedures in our study and most were performed laparoscopically (89%). 83% of these procedures were performed by general surgeons, mostly, with the patients under general anesthesia (95%). OPD was associated with a higher rate of perioperative deep organ infection (3.5% vs. 1.1%, p = 0.02) and need for reoperation (10.4% vs. 5.0%, p = 0.007). Operative time was, however, significantly longer with LPD (53.3 vs. 45.5 minutes, p < 0.001). In multivariate analysis, OPD was independently associated with increased risk of perioperative deep organ infection (odds ratio (OR) 3.7,95%, Confidence Interval (CI) 1.3 - 10.2, p = 0.01) and reoperation (OR 2.3, 95% CI 1.3 - 4.1, p = 0.005)., Conclusions: Laparoscopic PDC placement is more commonly performed and is associated with a lower risk of perioperative deep organ infection and reoperation than the open surgical approach. When possible, laparoscopic PDC placement might be preferable over open surgical placement.

Use of long-term dialysis catheters (e.g., tunneled dialysis catheters) predisposes patients to complications. While catheter-related bacteremia is one of the commonest encountered complication, there are a series of rare complications, namely catheter adherence to the vessel wall, catheter fracture, and vessel perforation, that can occur. This article attempts to discuss such complications with emphasis on potential risk factors, clinical presentations, and management options.

Visionary nephrologists in the early 1960s invented the dialysis machine, constructed arteriovenous shunts and fistulas, and designed vascular and peritoneal catheters to provide their patients with long-term dialysis. As the number of dialysis patients grew, the construction and care of vascular access was abandoned by nephrologists to surgeons and radiologists. There was a decline in the number of fistulas and an increase in grafts in the United States. Vascular access was not the first priority for the nonnephrologists, and this set the stage for the emergence of diagnostic and interventional nephrologists. These self-taught nephrologists trained others, resulting in a critical mass of subspecialists who founded the Society of Diagnostic and Interventional Nephrology. This review traces the origin of this exciting field from its pioneers to the society as it exists today. The future of this society depends on academic nephrology fellowship programs fostering training and research in this field.

Nephrologists have to place temporary dialysis catheters for hemodialysis in emergency situations. Since there is a dearth of literature on this subject, the authors have written guidelines for the safe and successful placement of these catheters. These instructions should be of help to nephrology trainees who want to master the art of central venous line placement. Based on their experience, the authors have provided a number of tips and techniques for temporary catheter placement in the femoral, internal jugular, and subclavian veins, with and without ultrasound guidance. Patient positioning, preparation of the catheter insertion tray, handling of ultrasound probe, cannulation of the central veins, and guide wire and dilator insertion are described in detail. These guidelines should assist the novice in placing temporary catheters with ease and with minimal complications.