Browse Ideas with tag 'failure to mature':

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  The next barrier - successful dialysis access needle insertion

  In dialysis access care centers with access coordinators, dedicated interventional nephrologists/radiologists, and available surgeons time to access creation and maturation by KDOQI guidelines (>6mm, >600ml/min,<6mm depth, though often after 6weeks) can increasingly be achieved. However, competence of needle insertion into new accesses is very variable among different dialysis units as well as among different staff at ...more »

  In dialysis access care centers with access coordinators, dedicated interventional nephrologists/radiologists, and available surgeons time to access creation and maturation by KDOQI guidelines (>6mm, >600ml/min,<6mm depth, though often after 6weeks) can increasingly be achieved. However, competence of needle insertion into new accesses is very variable among different dialysis units as well as among different staff at the same unit. Economic pressures are often mentioned as one obstacle, however, the magnitude of the problem is completely unknown.

  Studies need to be performed that a) document the true frequency of access infiltrations (minor and major), b) test the success of staff training models, c) compare button hole with conventional needle insertion technique, d) compare novel button hole device aids in certain populations.

  The large dialysis providers in the US should participate in this effort (financially).

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  Submitted by Dirk Hentschel 2 years ago

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  Diameter of arterial anastomosis governs successful maturation

  Large trials of autologous accesses (fistulas) in the US have been limited in their interpretative value by higher than before reported failure-to-mature rates. This contrasts sharply with the experience of dedicated centers of dialysis access excellence in England, Germany or France. A uniform finding in interviews with European experts, which in fact is mirrored by access focused surgeons in the US, is that choosing ...more »

  Large trials of autologous accesses (fistulas) in the US have been limited in their interpretative value by higher than before reported failure-to-mature rates. This contrasts sharply with the experience of dedicated centers of dialysis access excellence in England, Germany or France. A uniform finding in interviews with European experts, which in fact is mirrored by access focused surgeons in the US, is that choosing the diameter of the anastomosis matters.

  A randomized trial of upper arm brachial-cephalic autologous accesses randomized to 3-4mm diameter versus 6-8mm diameter anastomosis should be performed.

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  Submitted by Dirk Hentschel 2 years ago

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  AVF Maturation

  1. Arteriovenous Fistula (AVF) Maturation Although AVFs are the preferred form of dialysis vascular access, over 60% of surgically created AVFs are not suitable for dialysis between 4-5 months post surgery; often resulting in prolonged catheter dependency. Observational and randomized studies which could focus on one or all of the following are desperately needed: (a) pre-surgery arterial and venous vascular evaluation ...more »

  1. Arteriovenous Fistula (AVF) Maturation

  Although AVFs are the preferred form of dialysis vascular access, over 60% of surgically created AVFs are not suitable for dialysis between 4-5 months post surgery; often resulting in prolonged catheter dependency. Observational and randomized studies which could focus on one or all of the following are desperately needed: (a) pre-surgery arterial and venous vascular evaluation (b) surgical technique including experience of operator (c) physical and pharmacological therapy at different temporal periods following creation, (d) endovascular and surgical intervention for the non-maturing access (e) evaluation of novel local therapeutic interventions to enhance AVF maturation (cells, drugs, chemicals, genes and devices) (f) optimization of upstream hemodynamics (g) advances in cannulation technologies (h) process of care interventions focused on logistics and communication. This idea was identified as a priority area of research by the ASN Interventional Nephrology Advisory Group and the American Society of Interventional Nephrology.

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  Submitted by Anil Agarwal 2 years ago

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