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Diagnostics (Basel, Switzerland) Jun 2024: The ability of hemoglobin to bind and dissociate oxygen is crucial in delivering oxygen to tissues and is influenced by a range of physiological states, compensatory...
: The ability of hemoglobin to bind and dissociate oxygen is crucial in delivering oxygen to tissues and is influenced by a range of physiological states, compensatory mechanisms, and pathological conditions. This may be illustrated by the oxyhemoglobin dissociation curve (ODC). The key parameter for evaluating the oxygen affinity to hemoglobin is p50. The aim of this study was to evaluate the impact of hemodialysis on p50 in a group of patients with chronic kidney disease (CKD). An additional goal was to assess the correlation between p50 and the parameters of erythropoiesis, point-of-care testing (POCT), and other laboratory parameters. : One hundred and eighty patients (106 male, 74 female), mean age 62.5 ± 17 years, with CKD stage G4 and G5 were enrolled in this cross-sectional study. Patients were divided into two groups, including 65 hemodialysis (HD) patients and 115 patients not receiving dialysis (non-HD). During the standard procedure of arteriovenous fistula creation, blood samples from the artery (A) and the vein (V) were taken for POCT. The causes of CKD, as well as demographic and comorbidity data, were obtained from medical records and direct interviews. : The weekly dose of erythropoietin was higher in HD patients than in non-HD patients (4914 ± 2253 UI vs. 403 ± 798 UI, < 0.01), but hemoglobin levels did not differ between these groups. In the group of non-HD patients, more advanced metabolic acidosis (MA) was found, compared to the group with HD. In arterial and venosus blood samples, the non-HD group had significantly lower pH, pCO and HCO. This group had a higher proportion of individuals with MA with HCO < 22 mmol/L (42% vs. 24%, < 0.01). The absolute difference of p50 in arterial and venous blood was determined using the formula Δp50 = (p50-A) - (p50-V). Δp50 was significantly higher in the HD group in comparison to non-HD (0.08 ± 2.05 mmHg vs. -0.66 ± 1.93 mmHg, = 0,02). There was a negative correlation between pH and the p50 value in arterial (pH-A vs. p50-A, r = -0.56, < 0.01) and venous blood (pH-V vs. p50-V, r = -0.45, < 0.01). In non-HD patients, hemoglobin levels correlated negatively with p50 (r = -0.29, < 0.01), whereas no significant relation was found in HD patients. : The ODC in pre-dialysis CKD (non-HD) patients is shifted to the right due to MA, and this is an additional factor influencing erythropoiesis. Hemodialysis restores the natural differences in hemoglobin's dissociation characteristics in the arterial and venous circulation.
PubMed: 38928635
DOI: 10.3390/diagnostics14121219 -
Journal of Nursing Measurement Jun 2024To validate the scales of knowledge, attitude, and practice of self-care for arteriovenous fistulas in renal patients on hemodialysis. A methodological study verified...
To validate the scales of knowledge, attitude, and practice of self-care for arteriovenous fistulas in renal patients on hemodialysis. A methodological study verified the evidence of validity based on the content, response processes, and internal structure of the scales. The content was evaluated by six judges, and the response processes were verified with six patients. In the evaluation of the internal structure, the scales were applied to 220 patients for exploratory factor analysis with evaluation of McDonald's omega adjustment and calculation indexes. The scales explained variance and McDonald's omega values of 40.4%/0.896, 60.7%/0.843, and 36.9%/0.702 for the knowledge (19 items), attitude (4 items), and practice (8 items), respectively. The scale of attitude was valid after the analysis of the content evidence, response processes, and internal structure. The arteriovenous fistula self-care knowledge and practice scales explained less than 50% of the constructs. Therefore, it is recommended that new studies be conducted to validate scales of knowledge and practice of fistula self-care.
PubMed: 38925870
DOI: 10.1891/JNM-2023-0100 -
Hemodialysis International.... Jun 2024Few studies have reported the application of vacuum-sealing drainage of infected dialysis vascular access wounds. Herein, we present a case of buttonhole-related...
Few studies have reported the application of vacuum-sealing drainage of infected dialysis vascular access wounds. Herein, we present a case of buttonhole-related arteriovenous fistula infection treated with vacuum-sealing drainage. A 53-year-old female hemodialysis patient was hospitalized with an inflamed arteriovenous fistula. The patient underwent non-tunneled catheterization for dialysis and was treated with moxifloxacin and vancomycin for staphylococcal infection. On Day 3, the skin overlying the inflamed fistula was ulcerated, resulting in severe hemorrhage. Emergency surgery was performed along with vacuum-sealing drainage for fistula reconstruction. Vacuum-sealing drainage accelerated the recovery of the wound without complications. No further access complications occurred during over a 3-year follow-up.
PubMed: 38924346
DOI: 10.1111/hdi.13164 -
Revista Latino-americana de Enfermagem 2024to evaluate the effect of an educational video on the knowledge, attitude, and practice of self-care with arteriovenous fistula in patients undergoing hemodialysis... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
to evaluate the effect of an educational video on the knowledge, attitude, and practice of self-care with arteriovenous fistula in patients undergoing hemodialysis treatment.
METHOD
randomized controlled clinical trial, with two arms and single-blind. The intervention used an educational video on arteriovenous fistula self-care. The Fistula Self-Care Knowledge, Attitude, and Practice Scale was applied to 27 renal patients on hemodialysis in the control group and 28 in the intervention group at baseline, after seven and fourteen days. The data was analyzed using the Statistical Package for the Social Sciences software, using the chi-square test, Student's t-test, Mann-Whitney test, and Friedman's test with post-hoc analysis for multiple comparisons.
RESULTS
there were statistically significant differences in the knowledge and practice of self-care with the fistula at 0, 7 and, 14 days in the intervention (p= 0.004 and p<0.001, respectively) and control groups (p<0.001 for knowledge and practice). Attitude showed a significant difference at follow-up (p<0.001), but the post-hoc analysis did not confirm the significance obtained.
CONCLUSION
patients' knowledge and practice showed significant increases at follow-up in the control and intervention groups, while the increase in attitude was not significant in either group. Clinical trial, registration number: U1111-1241-6730.
Topics: Humans; Self Care; Female; Male; Patient Education as Topic; Single-Blind Method; Middle Aged; Renal Dialysis; Arteriovenous Shunt, Surgical; Video Recording; Health Knowledge, Attitudes, Practice; Adult; Aged
PubMed: 38922264
DOI: 10.1590/1518-8345.6949.4185 -
Nephrologie & Therapeutique Jun 2024We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients....
INTRODUCTION
We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses.
MATERIALS
All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible.
RESULTS
Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled.
DISCUSSION
The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.
Topics: Humans; Hemodialysis, Home; Arteriovenous Shunt, Surgical; Pilot Projects; Female; Male; Punctures; Middle Aged; Aged; Catheterization; Kidney Failure, Chronic
PubMed: 38920045
DOI: 10.1684/ndt.2024.82 -
Annals of Vascular Diseases Jun 2024Ruptured abdominal aortic aneurysms and common iliac artery aneurysms (CIAAs) are rarely associated with an arteriovenous fistula (AVF). In such cases, surgery is...
Ruptured abdominal aortic aneurysms and common iliac artery aneurysms (CIAAs) are rarely associated with an arteriovenous fistula (AVF). In such cases, surgery is frequently extremely difficult and the prognosis is usually poor. We report a case of a ruptured CIAA with a common iliac AVF in a 58-year-old male patient who presented with symptoms of severe edema in his left lower extremity. We used an aneurysm wall patch to repair the fistula and successfully reconstruct the common iliac vein, and a bifurcated prosthetic graft for abdominal aortic and iliac artery replacement.
PubMed: 38919327
DOI: 10.3400/avd.cr.23-00122 -
ACS Applied Materials & Interfaces Jun 2024In the context of arteriovenous fistula (AVF) failure, local delivery enables the release of higher concentrations of drugs that can suppress neointimal hyperplasia...
In the context of arteriovenous fistula (AVF) failure, local delivery enables the release of higher concentrations of drugs that can suppress neointimal hyperplasia (NIH) while reducing systemic adverse effects. However, the radiolucency of polymeric delivery systems hinders long-term in vivo surveillance of safety and efficacy. We hypothesize that using a radiopaque perivascular wrap to deliver anti-NIH drugs could enhance AVF maturation. Through electrospinning, we fabricated multifunctional perivascular polycaprolactone (PCL) wraps loaded with bismuth nanoparticles (BiNPs) for enhanced radiologic visibility and drugs that can attenuate NIH─rosuvastatin (Rosu) and rapamycin (Rapa). The following groups were tested on the AVFs of a total of 24 Sprague-Dawley rats with induced chronic kidney disease: control (i.e., without wrap), PCL-Bi (i.e., wrap with BiNPs), PCL-Bi-Rosu, and PCL-Bi-Rapa. We found that BiNPs significantly improved the wraps' radiopacity without affecting biocompatibility. The drug release profiles of Rosu (hydrophilic drug) and Rapa (hydrophobic drug) differed significantly. Rosu demonstrated a burst release followed by gradual tapering over 8 weeks, while Rapa demonstrated a gradual release similar to that of the hydrophobic BiNPs. In vivo investigations revealed that both drug-loaded wraps can reduce vascular stenosis on ultrasonography and histomorphometry, as well as reduce [F]Fluorodeoxyglucose uptake on positron emission tomography. Immunohistochemical studies revealed that PCL-Bi-Rosu primarily attenuated endothelial dysfunction and hypoxia in the neointimal layer, while PCL-Bi-Rapa modulated hypoxia, inflammation, and cellular proliferation across the whole outflow vein. In summary, the controlled delivery of drugs with different properties and mechanisms of action against NIH through a multifunctional, radiopaque perivascular wrap can improve imaging and histologic parameters of AVF maturation.
PubMed: 38912610
DOI: 10.1021/acsami.4c06042 -
Vascular Jun 2024When all access options in the upper extremity have been exhausted, an autologous access can be created in lower extremity. The purpose of this study is to report our...
INTRODUCTION
When all access options in the upper extremity have been exhausted, an autologous access can be created in lower extremity. The purpose of this study is to report our experience with superficial femoral vein transposition (SFVT) results in terms of postoperative complication and patency rate.
MATERIALS AND METHODS
In the time period from January 1, 2019 to April 30, 2021, thirty-five cases of SFVT performed at our large tertiary care center Sindh Institute of Urology and Transplantation (SIUT). All patients had exhausted upper arm veins or had central vein obstructions. Medical records of all patients were traced, patients were interviewed using a standard proforma and evaluated the current AVF function in the OPD clinic or by telephone calls. Data including demographics and postoperative complications were collected.
RESULTS
Thirty-nine cases of SFVT performed at our institute. Three were immediately lost to follow up so they were excluded from the study. Mean patient age was 30 ± 13.4 years. Most of our patients were females (57%) and 15 males (43%) with an average age of 29.05 years. The most common underlying renal diseasewas unknown in 16 (45%).Thirty-five patients included in the analysis; out of which primary failure observed in 4 patients, three patients were expired before fistula maturation and 3 were expired before 6 months. The remaining 25 fistulas patency rates were estimated. No any patient died due to fistulas related complication; patients died due to their primary disease.
CONCLUSION
Our study shows that with appropriate patient selection, SFVT have low infection rates and patency that is comparable with other access types.
PubMed: 38912558
DOI: 10.1177/17085381241262919 -
Journal of Neuroendovascular Therapy 2024Neurofibromatosis type 1 (NF1) is associated with vascular fragility, which results in aneurysms, arteriovenous fistulas, and dissections. Here, we describe a case of...
OBJECTIVE
Neurofibromatosis type 1 (NF1) is associated with vascular fragility, which results in aneurysms, arteriovenous fistulas, and dissections. Here, we describe a case of endovascular treatment of a ruptured occipital artery aneurysm that occurred after a craniotomy in a patient with NF1.
CASE PRESENTATION
A 46-year-old man with a history of NF1 underwent a right lateral suboccipital craniotomy to remove a cavernous hemangioma in the right middle cerebellar peduncle. Severe bleeding occurred in the occipital artery during the craniotomy. Due to vessel fragility, coagulation and ligation were not possible, and pressure hemostasis was achieved using cellulose oxide and fibrin glue. On postoperative day 12, the patient developed a sudden swelling on the right side of the neck as well as tracheal compression. Contrast-enhanced CT revealed a ruptured aneurysm in the right occipital artery. Transarterial embolization was performed under general anesthesia the same day. Right external carotid angiography showed an 18-mm-diameter fusiform aneurysm in the occipital artery. The aneurysm ruptured inferiorly to form a large pseudoaneurysm with significant jet flow. An arteriovenous fistula was also observed in a nearby vein. A microcatheter was inserted into the fusiform aneurysm under proximal blood flow control, and embolization was performed using coils and -butyl-2-cyanoacrylate.
CONCLUSION
Compared to surgical repair of ruptured occipital artery aneurysms, endovascular treatment appears to be safe, effective, minimally invasive, and rapid. Ruptured occipital artery aneurysms in NF1 patients can cause neck swelling and airway compression and should be recognized as a potentially lethal condition.
PubMed: 38911485
DOI: 10.5797/jnet.cr.2023-0098 -
Journal of Zhejiang University.... Jun 2024Artificial vascular graft (AVG) fistula is widely used for hemodialysis treatment in patients with renal failure. However, it has poor elasticity and compliance, leading...
Artificial vascular graft (AVG) fistula is widely used for hemodialysis treatment in patients with renal failure. However, it has poor elasticity and compliance, leading to stenosis and thrombosis. The ideal artificial blood vessel for dialysis should replicate the structure and components of a real artery, which is primarily maintained by collagen in the extracellular matrix (ECM) of arterial cells. Studies have revealed that in hepatitis B virus (HBV)-induced liver fibrosis, hepatic stellate cells (HSCs) become hyperactive and produce excessive ECM fibers. Furthermore, mechanical stimulation can encourage ECM secretion and remodeling of a fiber structure. Based on the above factors, we transfected HSCs with the hepatitis B viral X () gene for simulating the process of HBV infection. Subsequently, these -HSCs were implanted into a polycaprolactone-polyurethane (PCL-PU) bilayer scaffold in which the inner layer is dense and the outer layer consists of pores, which was mechanically stimulated to promote the secretion of collagen nanofiber from the -HSCs and to facilitate crosslinking with the scaffold. We obtained an ECM-PCL-PU composite bionic blood vessel that could act as access for dialysis after decellularization. Then, the vessel scaffold was implanted into a rabbit's neck arteriovenous fistula model. It exhibited strong tensile strength and smooth blood flow and formed autologous blood vessels in the rabbit's body. Our study demonstrates the use of human cells to create biomimetic dialysis blood vessels, providing a novel approach for creating clinical vascular access for dialysis.
Topics: Rabbits; Animals; Hepatic Stellate Cells; Renal Dialysis; Polyesters; Viral Regulatory and Accessory Proteins; Tissue Scaffolds; Transfection; Bionics; Polyurethanes; Blood Vessel Prosthesis; Extracellular Matrix; Humans; Hepatitis B virus; Collagen; Tissue Engineering; Trans-Activators
PubMed: 38910495
DOI: 10.1631/jzus.B2300479