Fistulas are the preferred permanent hemodialysis vascular access but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to (1) identify preoperative clinical characteristics that are predictive of fistula FTM and (2) use these predictive factors to develop and validate a scoring system to stratify the patient's risk for FTM. From a derivation set of 422 patients who had a first fistula created, a prediction rule was created using multivariate stepwise logistic regression. The model was internally validated using split-half cross-validation and bootstrapping techniques. A simple scoring system was derived and externally validated on 445 different, prospective patients who received a new fistula at five large North American dialysis centers. The clinical predictors that were associated with FTM were aged >65 yr (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.25 to 3.96), peripheral vascular disease (OR 2.97; 95% CI 1.34 to 6.57), coronary artery disease (OR 2.83; 95% CI 1.60 to 5.00), and white race (OR 0.43; 95% CI 0.24 to 0.75). The resulting scoring system, which was externally validated in 445 patients, had four risk categories for fistula FTM: low (24%), moderate (34%), high (50%), and very high (69%; trend P < 0.0001). A preoperative, clinical prediction rule to determine fistulas that are likely to fail maturation was created and rigorously validated. It was found to be simple and easily reproducible and applied to predictive risk categories. These categories predicted risk of FTM to be 24, 34, 50, and 69% and are dependent on age, coronary artery disease, peripheral vascular disease, and race. The clinical utility of these risk categories in increasing rates of permanent accesses requires further clinical evaluation.

Background: Determination of pulmonary vascular resistance (PVR) in patients with

RV myocardial strain correlates significantly with pulmonary hemodynamics in patients with pulmonary hypertension and normal left ventricular function. However, there is no correlation with RV performance in patients with left ventricular dysfunction.

Background-Myocardial recovery after VAD is rare but appears more common in non-ischemic cardiomyopathies (NICM). We sought to evaluate left ventricular (LV) end diastolic diameter (LVEDD) for predicting recovery after ventricular assist device (VAD).

Objective To review the feasibility of undertaking elective hernia repair in peritoneal dialysis (PD) patients without converting them to hemodialysis. Design A 10-year retrospective review of prospectively collected data. Setting PD unit of a university-based hospital. Patients and Methods All patients received regular exchanges until the morning of the surgery and remained off dialysis for the first 48 hours postoperatively. After that, PD was gradually reintroduced. The patients on continuous ambulatory PD (CAPD) received intermittent PD (IPD) 3 times per week for 10 hours per day for 2 weeks, followed by 5 exchanges of low volume (1 – 1.5 L) CAPD for 2 weeks, returning to the pre-surgery prescription by 4 weeks. Patients on continuous cycling PD (CCPD) received 1 week of IPD followed by 4 weeks of nocturnal IPD and returned to the original dose in 5 weeks. Between 1 April 1995 and 31 March 2005, 50 consecutive patients were managed by this protocol. Average age was 65 years and 67.7% were males. The original disease was diabetes mellitus (19 patients), hypertension ( 6 ), chronic glomerulonephritis (13), polycystic kidney disease ( 6 ), and others ( 6 ). The types of abdominal hernias included umbilical (25 patients), inguinal (18), incisional ( 5 ), and epigastric ( 2 ). 42 patients were on CAPD and 8 on CCPD. Average duration of PD prior to development of hernia was 16.4 months. Results Average pre-surgery creatinine was 673 μmol/L, increasing to 968 μmol/L on IPD. Serum potassium increased from 3.4 to 4.7 mmol/L. No episodes of hyperkalemia were noted. The average total follow-up was 33.4 months. None of the patients had leakage or early hernia recurrence due to early resumption of PD; 13 patients had recurrence of the same hernia after a median 19.9 months; 4 patients had hernias at different sites after an average of 55 months. Conclusions Based on this experience, we recommend that PD patients undergoing elective abdominal hernia surgery should continue PD according to the prescribed protocol. Interim hemodialytic support does not appear to be necessary in most patients.