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Open AccessArticle

Why Does Vascular Access Dysfunction Occur despite Brachial Artery Blood Flow Being Higher than Preset Blood Flow?

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Kidney Dial. 2022, 2(1), 38-43; https://doi.org/10.3390/kidneydial2010005 - 14 Jan 2022

Cited by 1 | Viewed by 1867

Abstract

Background: In recent years, many reports have investigated the usefulness of brachial artery blood flow (BAF) measured by ultrasonography as an evaluation index for the vascular access (VA) stenosis of hemodialysis patients. However, the mechanism of VA dysfunction, despite BAF being higher than [...] Read more.

Background: In recent years, many reports have investigated the usefulness of brachial artery blood flow (BAF) measured by ultrasonography as an evaluation index for the vascular access (VA) stenosis of hemodialysis patients. However, the mechanism of VA dysfunction, despite BAF being higher than the preset blood flow, has not been clarified to date. Methods: The relationship between actual blood-removal flow and recirculation rate with decreasing VA flow was examined using a VA flow path model and pure water as a model fluid. The blood-flow rate was set at 180 mL/min, and the set VA flow rate was lowered stepwise from 350 to 50 mL/min. VA flow rate, blood-removal flow rate, and flow waveform measured between two needle-puncture sites were recorded, and then the actual blood-removal flow rate and recirculation rate were calculated. Results: Recirculation was observed at a VA flow rate < 300 mL/min. The recirculation was due to the VA flow rate, which was transiently reduced to the level below the blood-removal flow rate, resulting in backflow. In contrast, no decrease in the actual blood-removal flow rate was observed. Conclusion: It is suggested that the mechanism of the VA dysfunction, despite the BAF being higher than the preset blood-flow rate, was due to the diastolic BAF being lower than the blood-removal flow rate. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Review

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Open AccessReview

Dialysis Access and Preemptive Kidney Transplantation

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Kidney Dial. 2021, 1(2), 79-87; https://doi.org/10.3390/kidneydial1020012 - 24 Sep 2021

Viewed by 2121

Abstract

Sustainable vascular or peritoneal access for dialysis is very important for patients undergoing dialysis therapy, and access trouble is occasionally involved with unexpected occurrence of complications. Once access trouble occurs, dialysis therapy might be discontinued and be followed by a life-threatening state of [...] Read more.

Sustainable vascular or peritoneal access for dialysis is very important for patients undergoing dialysis therapy, and access trouble is occasionally involved with unexpected occurrence of complications. Once access trouble occurs, dialysis therapy might be discontinued and be followed by a life-threatening state of patients with end-stage kidney disease. Bacterial infection, massive bleeding, and thrombosis in patients undergoing hemodialysis and acute infectious peritonitis and chronic encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis are important clinical issues. Preemptive kidney transplantation prior to dialysis has several advantages over transplantation after exposure to dialysis therapy. One of the notable advantages is the lack of necessity of dialysis access, which avoids access operations before transplantation. However, some transplant recipients may need short-term dialysis therapy due to the unexpected progression of chronic renal dysfunction. Dialysis access is required in a short preoperative period for preconditioning. The selection of renal replacement therapy without complications in a short-term dialysis before transplant surgery is important for the success of kidney transplantation. Appropriate preparation of short-term dialysis therapy and access is a key to success of preemptive kidney transplantation. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

Open AccessReview

Pathophysiology of High Flow Access and Surgical Flow Reduction Procedures

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Takehisa Nojima

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Yasuki Motomiya

Kidney Dial. 2021, 1(1), 36-46; https://doi.org/10.3390/kidneydial1010007 - 11 Jul 2021

Cited by 1 | Viewed by 3476

Abstract

High flow access (HFA) is a condition in which hemodynamics is affected by a flow rate that is larger than the blood flow required for hemodialysis. HFA sometimes causes high output heart failure, venous hypertension, and dialysis access steal syndrome. Flow reduction is [...] Read more.

High flow access (HFA) is a condition in which hemodynamics is affected by a flow rate that is larger than the blood flow required for hemodialysis. HFA sometimes causes high output heart failure, venous hypertension, and dialysis access steal syndrome. Flow reduction is effective for improving symptoms, and various surgical procedures have been reported. HFA is recognized as a well-developed type of access due to its good access sound, thrill, and vessel diameter; also, HFA probably has good patency if not intervened with by flow reduction. Therefore, the blood flow reduction procedures used to treat HFA need to minimize disadvantages such as access thrombosis, insufficient blood flow, aneurysm formation, and infection due to therapeutic intervention while, at the same time, achieving symptom improvement and long-term patency. The surgical procedure used to correct HFA must be highly reproducible and simple. This article reviews the pathophysiology and surgical flow reduction procedures for HFA. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Open AccessFeature PaperReview

Drug-Coated Balloon for Arteriovenous Access Stenosis in Hemodialysis Patients

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Hyangkyoung Kim

Kidney Dial. 2021, 1(1), 20-28; https://doi.org/10.3390/kidneydial1010004 - 22 Jun 2021

Cited by 2 | Viewed by 2391

Abstract

Hemodialysis access stenosis is a pervasive problem that occurs due to the physiology of the high-flow circuit. Stenosis occurs due to endothelial and smooth muscle injuries that result in neointimal hyperplasia. Percutaneous transluminal angioplasty is the standard treatment for dialysis access-induced stenosis. Unfortunately, [...] Read more.

Hemodialysis access stenosis is a pervasive problem that occurs due to the physiology of the high-flow circuit. Stenosis occurs due to endothelial and smooth muscle injuries that result in neointimal hyperplasia. Percutaneous transluminal angioplasty is the standard treatment for dialysis access-induced stenosis. Unfortunately, it is also associated with vessel wall trauma, which causes further intimal hyperplasia and restenosis. Data from randomized controlled trials (RCTs) and systematic reviews of the use of drug-coated balloons (DCBs) for dialysis access stenosis have been controversial. While several single-center trials or RCTs have reported safe and effective use of DCBs, conflicting results still exist. Furthermore, paclitaxel is known to be associated with an increased mortality risk. Herein, we review the current evidence on the role of DCBs in the treatment of dialysis access stenosis. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Open AccessReview

iBTA-Induced Biotube^® Blood Vessels: 2020 Update

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Kidney Dial. 2021, 1(1), 3-13; https://doi.org/10.3390/kidneydial1010002 - 17 Jun 2021

Cited by 5 | Viewed by 2479

Abstract

Blood access is a lifeline for dialysis patients. However, serious problems such as stenosis or obstruction of access blood vessels, which are life-threatening conditions in daily clinical practice, still remain. One of the most promising candidates for solving these problems may be Biotube [...] Read more.

Blood access is a lifeline for dialysis patients. However, serious problems such as stenosis or obstruction of access blood vessels, which are life-threatening conditions in daily clinical practice, still remain. One of the most promising candidates for solving these problems may be Biotube blood vessels. More than 20 years have passed since the development of in-body tissue architecture (iBTA), a technology for preparing tissues for autologous implantation in patients. The tissues obtained by iBTA do not elicit immunological rejection, which is one of the ultimate goals of regenerative medical engineering; however, their practical applications were quite challenging. The seemingly unorthodox iBTA concepts that do not follow the current pre-established medical system may not be readily accepted in general medicine. In contrast, there are many diseases that cannot be adequately addressed even with the latest and most advanced medical technology. However, iBTA may be able to save patients with serious diseases. It is natural that the development of high-risk medical devices that do not fit the corporate logic would be avoided. In order to actively treat such largely unattached diseases, we started Biotube Co., Ltd. with an aim to contribute to society. Biotubes induced by iBTA are collagenous tubular tissues prepared in the patient’s body for autologous implantation. The application of Biotubes as tissues for vascular implantation has been studied for many years. Biotubes may have excellent potential as small-diameter artificial blood vessels, one of the most difficult to clinically achieve. Their possibility is currently being confirmed in preclinical tests. Biotubes may save hundreds of thousands of patients worldwide annually from amputation. In addition, we aim to eliminate the recuring access vascular problems in millions of dialysis patients. This study provides an update on the current development status and future possibilities of Biotubes and their preparation molds, Biotube Makers. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Other

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Open AccessCase Report

A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

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Kidney Dial. 2021, 1(1), 74-78; https://doi.org/10.3390/kidneydial1010011 - 18 Sep 2021

Viewed by 2571

Abstract

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case [...] Read more.

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Open AccessProject Report

Overseas Support in the Field of Vascular Access

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Kidney Dial. 2021, 1(1), 53-60; https://doi.org/10.3390/kidneydial1010009 - 10 Aug 2021

Viewed by 1838

Abstract

Since joining the Non-Governmental Organization Ubiquitous Blood Purification International in 2014, professionals who are mainly members of the Japanese Society for Dialysis Therapy (JSDT) have worked toward promoting dialysis therapy in several countries through help with organization of local nephrology societies and conducting [...] Read more.

Since joining the Non-Governmental Organization Ubiquitous Blood Purification International in 2014, professionals who are mainly members of the Japanese Society for Dialysis Therapy (JSDT) have worked toward promoting dialysis therapy in several countries through help with organization of local nephrology societies and conducting educational activities. Since 2016, training at our hospital has been provided for doctors and dialysis staff from these countries as part of the activities of the JSDT. These activities also involve technical training for vascular access (VA) surgery and management. To date, lectures and practical teaching on VA procedures have been given in Cambodia and Vietnam, and a hands-on seminar on echo-guided puncture and VA management was held in Mongolia. In Mongolia and Myanmar, a plan to provide systemic VA surgery education has been developed, at the request of local nephrology societies. Doctors and medical staff from Vietnam, Laos, Cambodia, Nepal and Indonesia have visited our hospital and have observed operations as part of their training. To achieve sustainable medical support and academic activities, we have found it to be important to have a counterpart society in each country, and guidance has been provided when required on organization of a national nephrology society. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Open AccessPerspective

How to Prevent Peritoneal Dialysis Catheter Tip Migration: A Japanese Perspective

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Minoru Ito

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Masataka Koshika

Kidney Dial. 2021, 1(1), 29-34; https://doi.org/10.3390/kidneydial1010005 - 05 Jul 2021

Cited by 1 | Viewed by 4572

Abstract

The prevention of peritoneal dialysis (PD) catheter complications is essential to achieve a successful outcome. In recent years, nephrologists have performed more PD catheter insertion surgeries in Japan. The prevention of catheter complications is crucial for nephrologists who do not have all-around surgical [...] Read more.

The prevention of peritoneal dialysis (PD) catheter complications is essential to achieve a successful outcome. In recent years, nephrologists have performed more PD catheter insertion surgeries in Japan. The prevention of catheter complications is crucial for nephrologists who do not have all-around surgical skills. PD catheter tip migration is a common complication and a significant cause of catheter malfunction. Several preventive techniques have been reported for the PD catheter tip migration. This perspective described the following: (1) surgical technique in laparotomy, (2) laparoscopic surgery, (3) peritoneal wall anchor technique, and (4) catheter type selection. We hope that more effective methods of preventing catheter complications will be developed to ensure the success of PD treatment. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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Open AccessCase Report

A Case of a Patient Who Successfully Achieved Early Wound Closure by Local Negative Pressure Wound Therapy (NPWT) against Compromised Wound Healing after Arterio-Venous Graft Infection

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Kidney Dial. 2021, 1(1), 14-19; https://doi.org/10.3390/kidneydial1010003 - 22 Jun 2021

Viewed by 2382

Abstract

The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure [...] Read more.

The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure wound therapy (NPWT) is a non-invasive procedure that promotes wound healing by sealing the wound under negative pressure. Although NPWT is practically accepted in general surgery, there are only a few reports of this strategy to the vascular access operation for patients with hemodialysis due to the possibility of severe bleeding. In the present report, we report a case of a patient who successfully achieved safe and early wound closure by NPWT against compromised wound healing after AVG infection. Full article

(This article belongs to the Special Issue Dialysis Access—A New Era)

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