Contemporary outcomes of precision banding for high flow hemodialysis access.

Objective: High-flow hemodialysis accesses are a well-recognized source of patient morbidity. Among available management strategies inflow constriction based on real-time physiologic flow monitoring offers a technically straightforward data-driven approach with potentially low morbidity. Despite the benefits offered by this approach, large contemporary series are lacking.

Point-of-care Vascular Ultrasound: Of Fistulas and Flows.

Point-of-care ultrasound (POCUS) is increasingly being used in nephrology as a diagnostic tool, and there is a growing interest among physicians and nursing staff to learn how to use POCUS for the evaluation of the dialysis vascular access (DVA). The goal of POCUS is to extend the physical examination and more closely evaluate the DVA at bedside. Typically, POCUS quickly answers yes-no questions (ie, Is the vein too deep? Y/N).

Fibrin sheath disruption during guidewire exchange for bacteremia: Low recurrence of infection and preservation of vascular access sites.

Background: Catheter-associated bacteremia (CAB) often leads to removal of tunneled dialysis catheters with delayed insertion (RDI). Exchange over a guidewire (ExW) can be considered for access site preservation. Fibrin sheath disruption (FSD) during exchange is not standard practice for infected catheters.

The Spiraling Case of a Yellow Chef: Isolated Hyperbilirubinemia.

Leptospirosis is a common bacterial disease in tropical regions of the world due to greater exposure to rodents and domestic animals; however, this condition can also occur in US urban areas, though it often goes unrecognized. Gastrointestinal symptoms are very commonly seen, and icteric leptospirosis is often confused for other conditions resulting in delayed diagnosis and worse outcomes. As mortality increases with more extensive hepatic involvement, gastroenterologists should be aware of the constellation of gastrointestinal symptoms related to leptospirosis, as it can occur in the absence of classic exposure history.