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Author(s): Brittany Garza [sup.1] , Jessica Geer [sup.1] , Sarah J. Swartz [sup.1] , Poyyapakkam Srivaths [sup.1] , Tam T. T. Huynh [sup.2] , Eileen D. Brewer [sup.1] Author Affiliations: [...], Background Arteriovenous fistula (AVF) is the preferred access for chronic hemodialysis (HD) in children and adolescents, but central venous catheter use is still high. Methods Retrospective chart review of children and adolescents with AVF created between January 2003 and December 2015 was performed to assess primary failure (PF), maturation time, functional primary and functional cumulative patency, and potential risk factors for AVF dysfunction. Results Ninety-nine AVF were created in 79 patients (54% male; 7-24 years; 16-147 kg) by experienced surgeons. Duplex ultrasonography vein mapping was used to assist with site selection. PF occurred in 17 AVF (17%) in 14 patients. Patient age, gender, ethnicity, underlying disease, time on dialysis, and AVF site were not associated with PF or patency. Coagulation abnormality was positively associated with PF (p = 0.03). Function was achieved in 82 AVF (83%) in 77 patients (97%). Median maturation time was 83 days (range 32-271). AVF were accessed via buttonholes. Functional primary patency was 95%, 84%, and 53% at 1, 2, and 5 years. Overall 1- and 2-year functional cumulative patency was 95%, but lower for small patients 16-30 kg (88%) and those greater than 80 kg (91%). The 5-year patency rate was 80%, but significantly lower for 16-30 kg (59%) and greater than 80 kg (55%). Risk analysis showed significantly better patency for 31-45 kg and 46-80 kg groups (p < 0.01), non-obese BMI (p = 0.01), and buttonhole self-cannulation (p = 0.03). Conclusions This study provides more information about successful AVF with buttonhole cannulation in pediatric hemodialysis patients lending additional support for AVF use in pediatrics. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Author(s): Neziha Celebi [sup.1] , Jesus G. Vallejo [sup.2] , Olive S. Eckstein [sup.3] , Jessica Geer [sup.1] , Jyotinder N. Punia [sup.4] , Ewa Elenberg [sup.1] Author Affiliations: (Aff1) [...]

Author(s): Jessica J. Geer[sup.1] [sup.2] , Shweta Shah[sup.2] , Eric Williams[sup.3] , Ayse Akcan Arikan[sup.2] [sup.3] , Poyyapakkam Srivaths[sup.2] Author Affiliations: (1) Pediatric Hemodialysis Unit, Texas Children's Hospital Houston, 1102 [...], Background Intradialytic hypotension and myocardial stunning are proposed as contributing to the pathogenesis of increased cardiovascular disease burden and death in patients receiving maintenance hemodialysis (HD). Noninvasive cardiac output measurements provide a dynamic, real-time assessment of hemodynamic parameters. We investigated intradialytic changes in hemodynamic parameters in pediatric outpatients receiving chronic HD and determined patient and treatment risk factors associated with such intradialytic changes. Methods Hemodialysis was performed using linear fluid removal over 4 h with polysulfone dialyzers. Continuous wave Doppler ultrasound was used to measure hemodynamic parameters prior, 2 h into, and after the mid-week HD treatment session. Pulse wave tonometry was performed at the same time. The percentage change in blood volume was measured by noninvasive hematocrit monitoring during HD. Results Twenty-two patients fit the inclusion criteria, of whom 16 (73 %) were male. The mean age of the patients was 17 ± 3.8 years, and the dialysis vintage was 47.8 ± 33.7 months. The cardiac index decreased significantly midway through the HD treatment session and remained low until the end of treatment. A significant decline in cardiac index without hypotension occurred in 12 (54 %) patients. Expected increase in systemic vascular resistance index to preserve the cardiac index was not observed. Weight, percentage fluid overload, dialysis vintage, and adequacy did not correlate with the observed decline in the cardiac index. The decrease in blood volume at the 2 h (R = 0.43, p = 0.045) and 4 h (R = 0.56, p = 0.007) time points was the only factor associated with cardiac index decline. Conclusion The cardiac index and stroke volume decreased significantly during the HD session. Patients with larger blood volume changes during the first 2 h of HD and at 4 h showed a significant decrease in cardiac index that did not recover at the completion of the HD treatment. Rate of fluid removal was the only significant risk factor for compromised cardiac index during HD. Conventional methods currently used for assisting fluid removal in HD are inadequate to assess hemodynamic changes.

Introduction Patients maintained on chronic dialysis often require the administration of erythropoietin stimulating agents (ESA) to manage anemia. The National Kidney Foundation Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines recommend maintaining [...], Background Maintaining hemoglobin (Hgb) levels within a target range is difficult. Non-invasive hematocrit monitoring (NIVH) continuously monitors both the hematocrit and percent change in intravascular blood volume in real time. Based on the data reported here, NIVH can be utilized as a tool for anemia management in pediatric hemodialysis patients. Methods Monthly, mid-week pre-dialysis, Hgb levels were obtained for 12 consecutive months. Concurrent with monthly Hgb, hematocrit was recorded at the start of the dialysis treatment using NIVH. Hgb (oHgb) was calculated using the adult equation Hgb=0.3112*HCT+0.71, and a linear regression model was used to derive a pediatric specific equation (pHgb=0.28*CRIT Hct+2.5). Results A total of 310 observations were obtained from 47 patients. The mean actual hemoglobin (mHgb) was 11.14 ± 1.4, and the mean derived hemoglobin from the adult equation, oHgb, was 10.3 ± 1.3 (p=0.0001). For the target hemoglobin of 10-12 gm/dl, the adult equation was 72 % sensitive and 63 % specific, whereas the pediatric equation was 93 % sensitive and 70 % specific. Conclusions The newly derived pediatric equation (pHgb= 0.28*CRIT Hct+2.5) improved the prediction capability compared to the standard equation with lower false-negative and false-positive rates. Keywords Anemia * Hemoglobin * Pediatric * Hemodialysis * Non-invasive * Real-time

Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers.Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD.Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care.Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth.Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. [ABSTRACT FROM AUTHOR]

The article discusses a study that used interferon gamma release assays (IGRA) to diagnose latent tuberculosis (TB) infection in pediatric dialysis patients. The researchers screened children who were previously tuberculin skin test (TST) positive by IGRA alone. The results indicate that TB risk factors correlated poorly with IGRA-positivity.