Vascular Access Guidelines: Summary, Rationale, and Controversies

Sequeira, Adrian; Naljayan, Mihran; Vachharajani, Tushar J.

doi:10.1053/j.tvir.2016.11.001

Cited by 63 publications

(52 citation statements)

References 54 publications

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“…Hemodialysis (HD) is the most widely used dialysis therapy in the world, and vascular access represents an important risk factor for bacteremia, hospitalization, and mortality (Sesso et al, 2016;Niyyar, 2012;Lok and Mokrzycki, 2011;Al-Balas et al, 2017;Vascular Access 2006Work Group, 2006. In particular, catheter-related bloodstream infection (CR-BSI) is a severe complication that requires hospitalization, systemic antibiotic therapy, and removal, reinsertion or replacement of the catheter (The NIH, 2016;Lee, 2017;Sequeira et al, 2017). Various measures have been studied for the prevention of CR-BSI, one of which is the use of lock solutions (Katneni and Hedayati, 2007;Böhlke et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

Bueloni¹,

Marchi²,

Caetano

et al. 2019

International Journal of Infectious Diseases

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Background: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. Methods: A prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7 mg/ml + cefazolin 12 mg/ml + heparin 3500 IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4% + heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. Results: A total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1 = 0.79, group 2 = 1.10; p = 0.18) or exit site infection rates (events per 1000 catheter-days: group 1 = 2.45, group 2 = 1.83; p = 0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p = 0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19-0.91) and mechanical complications (HR 0.16, 95% CI 0.065-0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04-3.07) and mechanical complications (HR 5.64, 95% CI 1.65-19.3). Conclusions: The efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects.

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Section: Introductionmentioning

confidence: 99%

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

Bueloni¹,

Marchi²,

Caetano

et al. 2019

International Journal of Infectious Diseases

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“…По данным актуального регистра Российского диализного общества, на конец 2015 года из 33 365 пациентов 5,4% получали ГД через перманентный центральный венозный катетер (ЦВК), а 3,9%через временный ЦВК [11]. Несмотря на принцип fistula first [12,13], в США ГД с использованием ЦВК получает 21% пациентов, в Европе -28%. По данным всех крупных регистров [11,[14][15][16][17], количество больных, получающих лечение гемодиализом, ежегодно значительно увеличивается, а доля больных с ЦВК остается стабильной.…”

Section: Introductionunclassified

Central venous stenosis and methods of its treatment in hemodialysis patients

Карданахишвили

Зулькарнаев

2019

RJTAO

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“…Arteriovenous fistula (AVF) is regarded as the best vascular access for chronic haemodialysis (HD) in patients with end-stage renal disease (ESRD) [1, 2]. AVF provides better patient access and survival in comparison to arteriovenous grafts and central venous catheters, because with fewer access-related infections and endovascular interventions [3–5].…”

Section: Introductionmentioning

confidence: 99%

“…AVF referral within ∼12 months of the estimated time to dialysis performed best among time frame strategies, although the timing of referral is classically guided by the patient’s age and by his/her individual likelihood and rate of progression to ESRD [6, 7]. The AVF flows in the forearm usually reach 500–900 mL/min, whereas those in the upper arm are 900–1500 mL/min [2, 8]. Inherently, AVF causes significant haemodynamic changes in patients under chronic HD, which may lead to serious complications, including arterial steal, pulmonary hypertension (PH) and high-output cardiac failure [9].…”

Section: Introductionmentioning

confidence: 99%

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

Vanderweckene

Weekers

Lancellotti

et al. 2017

Clinical Kidney Journal

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Arteriovenous fistula (AVF) is regarded as the best vascular access for chronic haemodialysis (HD). Still, AVF inherently causes significant haemodynamic changes. Although the necessity for vascular access despite its putative cardiovascular complications favours AVF creation in patients under chronic HD, one may question whether sustaining a functional AVF after successful kidney transplantation extends the haemodynamic threat. Small prospective series suggest that AVF ligation causes rapid and sustained reduction in left ventricular hypertrophy. Still, the benefits of such a cardiac remodelling in long-terms of cardiovascular morbi-mortality still need to be proven. Furthermore, the elevation of diastolic blood pressure and arterial stiffness caused by AVF ligation may blunt the expected cardio-protection. Finally, the closure of a functioning AVF may accelerate the decline of kidney graft function. As a whole, the current management of a functioning AVF in kidney transplant recipients remains controversial and does not rely on strong evidence-based data. The individual risk of graft dysfunction and a return to chronic HD also needs to be balanced. Careful pre-operative functional assessments, including cardio-pulmonary testing and estimated glomerular filtration rate slope estimation, may help better selection of who might benefit the most from AVF closure. Large-scale prospective, ideally multi-centric, trials are essentially needed.

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Vascular Access Guidelines: Summary, Rationale, and Controversies

Cited by 63 publications

References 54 publications

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

Central venous stenosis and methods of its treatment in hemodialysis patients

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

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