Antiphospholipid Syndrome in a Patient With Autosomal Dominant Polycystic Kidney Disease: The Surface of the Moon.

Antiphospholipid syndrome (APS) is a rare coagulopathic disorder diagnosed with a combination of clinical/imaging findings with specific antibody titer elevations over a period of 12 weeks. The following case report will discuss the unusual and challenging hospital course of a patient with extensive autosomal dominant polycystic kidney disease (ADPKD) being treated for a multi-drug resistant urinary tract infection (UTI). The patient later developed multiple deep vein thrombosis (DVT) and was found to have antiphospholipid syndrome.

ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology.

Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities.

ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists.

Although not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management.

Changes in the Profile of Endovascular Procedures Performed in Freestanding Dialysis Access Centers over 15 Years.

Background And Objectives: Marked changes occurred in the vascular access profile of patients receiving hemodialysis in the United States over the 15-year period of 2001-2015. This study was undertaken to evaluate how these changes have affected dialysis access maintenance and salvage procedures performed in freestanding dialysis access centers and to examine the effectiveness, efficiency, and safety of these procedures in this setting.

Design, Setting, Participants, & Measurements: Data were collected from freestanding, dedicated dialysis access centers operating under a common system of management.

The risk of bleeding with tunneled dialysis catheter placement.

Purpose: The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications.

Methods: Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held.

Surgical site infection rates in dialysis patients undergoing endovascular procedures.

A surgical site infection (SSI) is an infection related to surgery that develops within 30 days after an operation or within 1 year of implant placement. Postoperative SSIs are the most common health-care-associated infections, occurring in up to 5% of surgical patients. Endovascular surgical procedures related to vascular access are common in the dialysis population and may cause SSIs.

Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries.

Dialysis vascular access (DVA) care is being increasingly provided in freestanding office-based centers (FOC). Small-scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4-year sample (2006-2009) of Medicare claims (USRDS) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department (HOPD).

Interventional nephrology: When should you consider a graft?

The patient's vascular access is critical in ensuring that hemodialysis is successful, effective, relatively uncomplicated, and consistently reproducible from one treatment to another. The choice of vascular access is dictated by a multitude of factors, some of which are generalizable to a larger system, and others of which are flavored by local experience and expertise; an important fraction is specific to the patient presenting to the clinician at a particular point in time. Some of these factors, such as patient age and sex, are not modifiable; others, like comorbidity, vessel size and urgency of presentation to the renal provider, are manageable and sometimes modifiable.

Radiation dose associated with dialysis vascular access interventional procedures in the interventional nephrology facility.

The number of dialysis access procedures performed by interventional nephrologists using a mobile C-arm fluoroscopy machine in freestanding centers continues to rise. With this activity comes the risk of radiation exposure to patients being treated and staff. This study was conducted to assess the levels of radiation dosage involved with these procedures.

The risk of sedation/analgesia in hemodialysis patients undergoing interventional procedures.

Data derived from a large cohort of hemodialysis patients (12,896) undergoing dialysis access maintenance procedures being performed by interventional nephrologists were analyzed to determine the safety of sedation/analgesia (S/A) in a freestanding facility. Data collected included patient demographics, procedures performed, time of procedures, drugs used, doses used, and complications that occurred. Four high-risk groups were identified based upon age, pulmonary status, and over all physical status.

Excimer laser assisted angioplasty in hemodialysis access intervention.

A case is described in which an excimer laser is used to assist angioplasty of a severe central venous lesion that is refractory to conventional techniques. Modern laser technology uses the ultraviolet (UV) spectral region to generate nanosecond pulses of energy. This results in photoablation, which is the process by which energy photons cause molecular bond disruption, while minimizing thermal damage to the surrounding vascular tissues.

Infection associated with tunneled hemodialysis catheters.

The use of tunneled dialysis catheters to deliver hemodialysis treatment may be associated with major problems. For this reason their use should be minimized as much as possible. Infection is the most serious of these problems.

The classification of procedure-related complications--a fresh approach.

As with any type of medical procedure, endovascular procedures result in procedure-related complications (PRCs). A PRC system as part of an outcome-based practice monitoring strategy is essential. Such a program should have several features.