Anemia is a common and important complication of chronic kidney disease. Treatment includes the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation. However, the optimal schedule of iron supplementation remains to be defined. Thirty-one long-term hemodialysis patients were treatedfor 1 year (period 1) with ESAs and an intermittent pulse regimen consisting of 100 mg of iron sucrose administered after different dialysis sessions depending on serum ferritin and other laboratory values, but no more than once per week. During the next 3 years (period 2), patients were treatedwith ESAs and need-based, continuous, low-dose iron. Iron doses were determined on the basis of values and changes of serum ferritin and transferrin saturation every fourth week after the longest interdialysis timeinterval. Iron doses ranged from 10 to 60 mg of iron sucrose and were given 1-3 times per week. If grounded, we gradually reduced or even abolished the iron doses. A significant increase in the hemoglobin concentration and hematocrit during period 2 in comparison with period 1 was observed. The use of ESAs did not change significantly during period 2 in comparison with period1, while the use of iron was significantly lower in period 2. Significantly lower values were obtained for serum ferritin, saturation of transferrin, serum iron, and total serum iron-binding capacity during period 2. A better response to ESA therapy (increase in hemoglobin and hematocrit) isachieved with need-based, continuous, low-dose iron replacement.
COBISS.SI-ID: 28023257
The aim of our retrospective study was to present the success of surgical thrombectomy in acutely thrombosed, arteriovenous (AV), expanded polytetrafluoroethylene (ePTFE) grafts. Patients from hemodialysis centers in Slovenia were admitted to our dialysis center after acute thrombosis of their AV graft to undergo surgical thrombectomy under local anesthesia as an outpatient procedure. In 55 chronic hemodialysis patients, of whom 26 were men(47.3%), with a mean age of 63 +/- 13 years (range 35-84 years), and diabetes mellitus in 11 patients (20%), 59 ePTFE AV grafts thrombosed. A totalof 129 thrombectomies were performed, on average 2.2 +/- 2.1 per graft (range 1-13). Primary patency (defined as the time from AV graft creation to first thrombosis) was 638 +/- 633 days (range 10-2586, median 418 days), secondary patency (defined as the time from first thrombectomy to abandonment)was 451 +/- 472 days (range 0-1994, median 305 days), and cumulative patency (defined as the time from creation to abandonment) was 1089+/- 685 days (range 25-3020, median 1031 days). In 46 (78%) of the AV grafts, the first thrombectomy was successful. The secondary patency rates after 1, 2, 3, 4, and 5 years were 76%, 66%, 54%, 14%, and 14%, respectively (13/59 unsuccessfully thrombectomized grafts were excluded). Cumulative patency after 1, 2, 3, 4, and 5 years was 88.1%, 67.8%, 44.7%, 27.1%, and 16.9%, respectively. In conclusion, surgical thrombectomy after thrombosis of an AV graft in the arm or thigh, performed by interventional nephrologists andfollowed, if required, by angioplasty, significantly prolonged the patency of the majority of thrombosed AV grafts.
COBISS.SI-ID: 28754905
Despite clinical guidelines and the possibility of diagnostic vascular imaging, creation and maintenance of a vascular access (VA) remains problematic: avoiding short- and long-term VA dysfunction is challenging. Although prognostic factors for VA dysfunction have been identified in previous studies, their potential interplay at a systemic level is disregarded. Consideration of multiple prognostic patient specific factors andtheir complex interaction using dedicated computational modeling tools might improve outcome after VA creation by enabling a better selection of VA configuration. These computational modeling tools are developed and validated in the ARCH project: a joint initiative of four medical centers and three industrial partners (FP7-ICT-224390). This paper reports the rationale behind computational modeling and presents the clinical study protocol designed for calibrating and validating these modeling tools. The clinical study is based on the pre-operative collection of structural and functional data at a vascular level, as well as a VA functional evaluation during the follow-up period. The strategy adopted to perform the study and for data collection is also described here.
COBISS.SI-ID: 29558489