End-stage renal disease and its treatment in Latin America in the twenty-first century.

The Latin American Society of Nephrology and Arterial Hypertension's Dialysis and Transplant Registry was chartered in 1991. It collects information on ESRD and its treatment in 20 countries of the region. The prevalence of patients on renal replacement therapy (RRT) increased from 129 pmp in 1992 to 447 pmp in 2004; in 2004, 56% of the patients were on hemodialysis, 23% on peritoneal dialysis, and 21% had a functioning kidney graft.

Interventional nephrology in Puerto Rico.

Vascular access is emerging as a critical issue for hemodialysis patients in Puerto Rico. In more than 50% of the hemodialysis patients, tunneled hemodialysis catheters are the sole access for providing dialysis therapy. Most disturbing is the fact that a significant number of these catheters are nontunneled temporary catheters, sometimes placed in the subclavian vein.

Brief report: successful extension of the transplant renal vein with a synthetic vascular graft.

Unexpected intraoperative vascular complications in the graft of the recipient during organ transplantation can be most vexing and require immediate attention and careful management so as not to impair the integrity and fate of the graft. We were confronted with a diabetic recipient with total fibrosis of the left iliac vein, patent inferior vena cava, totally and circumferentially calcified aorta and left iliac artery with the exception of a small area in the distal external iliac artery. The problem was solved by anastomosing the artery low onto the external iliac, and by interposing a venous polytetrafluoroethylene vascular graft between the renal vein and the inferior vena cava.

Swelling of the hand after arteriovenous fistula for hemodialysis.

Despite a high patency rate and low incidence of infections, several complications have been described with the Brescia subcutaneous arteriovenous fistula. We recently observed five patients with swelling of the hand and wrist secondary to increased distal vein flow. Ligation of the distal vein, with or without proximal reconstruction resulted in cure.