The “Rule of 6s” describes an easy way to evaluate the maturity of a recently-placed arteriovenous fistula for dialysis access–and is even mentioned by name in the most recent KDOQI Guidelines for Dialysis Access. The Rule of 6s…
Despite the knowledge that AV fistulas and grafts give superior outcomes when compared to dialysis catheters, there remain a large chunk of patients who begin dialysis without a fistula or graft. Conversely, there are also examples of “unnecessary…
Dialysis catheters: the bane of the renal fellow’s existence. I’m sure there are some of you who actually like putting in catheters and are quite good at it, and while I will admit that an efficient line placement…
A very significant percentages of ESRD patient admissions derive from clotted dialysis access–the “lifeline” dialysis patients require in order to survive on dialysis. Any maneuver or treatment which is successful in preventing, or even delaying, access thrombosis would…
The following “3 Key Facts Regarding Catheter-Related Bacteremia” are taken from Eliot Heher’s “MGH Nephrology Handbook” distributed to nephrology fellows every year which I find very helpful: Fact #1: Fever and chills are highly predictive of positive blood…
In the most recent issue of C-JASN there is an intriguing article entitled “Ethical and Legal Obligation To Avoid Long-Term Tunneled Catheter Access” by Rehman et al, in which the authors argue strongly that tunneled catheters should be…
Infectious metastases (e.g., infective endocarditis, epidural abscess, liver & lung abscesses, etc) are unfortunately not uncommon in the ESRD population, particularly in those with in-dwelling catheters. I have personally seen several cases of epidural abscesses as a fellow,…
In 2003, the Fistula First Initiative was enacted, in which an attempt is actively being made to get as many dialysis patients as possible to get dialyzed via an AV fistula. As AV fistulas have been perceived to…
We all realize that maintaining vascular access is a dialysis patient’s life-line. Many patients must undergo multiple interventional radiology or surgical procedures in order to sustain fistula or graft patency over a prolonged period of time. The physical…
A recent JAMA article (Parienti et al, JAMA 2008) was presented in journal club today which involved a randomized control trial looking at infectious and other complications seen in patients with acute kidney injury in an ICU who…
