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dialysis access

When To Refer For Dialysis Access?

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…

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Why doesn’t this catheter work?

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…

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Aggrenox for Maintaining AV Graft Patency?

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…

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“The Catheter Epidemic”

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…

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Epidural Abscesses in ESRD Patients

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,…

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Fistula First Controversy

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…

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Physical Exam for AV Fistulas & Grafts

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…

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