Maintaining Access Sites for Hemodialysis Continues to Pose Challenges

[Zach]

http://kidney.niddk.nih.gov/about/Research_Updates/KidneyDiseaseFall08/4.htm
Maintaining Access Sites for Hemodialysis Continues to Pose Challenges

Reducing early blood clots in bloodstream access for kidney failure treatment does not increase the chances of the access site becoming suitable for long-term dialysis.

The Dialysis Access Consortium (DAC), funded since 2000 by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), found that only 12 percent of patients developed blood clots in a fistula when treated with the clot-preventing drug clopidogrel, or Plavix, compared with nearly 20 percent of patients who did not take the drug. Despite this, about 60 percent of new fistulas in each group still could not be used for dialysis treatments. Complications such as bleeding were similar across the study groups.

A fistula—an enlarged vessel where blood is removed and returned to the body during dialysis treatments—is a type of vascular access for hemodialysis. While other types of dialysis vascular access such as synthetic grafts are available, fistulas are preferred because they are less likely than the others to clot and get infected. They also are less costly. However, the failure of fistulas to mature, or enlarge over time, can prevent their effective use. Clotting, infection, and low blood-flow rates in the access site are common reasons for hospitalization of hemodialysis patients, who then must undergo further treatments or surgeries to maintain their fistula.

Lifesaving Treatment
Surgeons create fistulas by joining a section of an artery and a vein to make one large vessel capable of handling high volumes of blood during hemodialysis, a treatment for people with kidney failure. Wastes and extra fluid are filtered from the bloodstream through the vascular access. Most of the 470,000 Americans with kidney failure depend on hemodialysis for survival.

The DAC studied nearly 900 participants at nine U.S. medical centers in academic and community practices in urban and rural settings. Participants received a new fistula and took Plavix or a placebo daily for 6 weeks to determine whether the drug would maintain blood flow in fistulas and increase the number of fistulas suitable for use in regular dialysis treatments.

“Because vascular access is critical for delivering lifesaving care, we are already organizing another multicenter study to better understand why some fistulas fail and how to improve their function once they are placed in dialysis patients,” said study co-author Catherine M. Meyers, M.D., a kidney specialist who oversees the DAC.

The NIDDK has a fact sheet about vascular access for hemodialysis at
www.kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess.

[Rerun]

This one says 470,000 people across the nation on dialysis.  Is there a true number?  Do they just make this shit up?  I guess it is safe to say "Over 20 people on dialysis across the nation"  470,000 is over 20. 

How many people are on dialysis across the Nation?  How many people are on the list waiting for a kidney transplant?  Different answers depending on who you ask.

Sorry!  Rant.             

[Zach]

This one says 470,000 people across the nation on dialysis.  Is there a true number?  Do they just make this shit up?  I guess it is safe to say "Over 20 people on dialysis across the nation"  470,000 is over 20. 

How many people are on dialysis across the Nation?  How many people are on the list waiting for a kidney transplant?  Different answers depending on who you ask.

Sorry!  Rant.             

Actually, you mis-read what the article said, which was: "Most of the 470,000 Americans with kidney failure depend on hemodialysis for survival." So they are not saying all of the 470,000 are on dialysis, just most.

As of 2006, the were 354,794 people on dialysis.  There were an additional 151,502 living with a transplant.
http://www.usrds.org/2008/ref/D_Treatment_Modalities_08.pdf
See page 14

And off course in the 2 years since these statistics were collected, the numbers most likely have increased.

[Bill Peckham]

Wouldn't one way to preserve veins for future use an an access would be to place a small graph to accommodate blood draws? When I was my Mom's caretaker last summer I saw how terrible and inconsistent blood draws are in the hospital and how many there are. If you had deteriorating kidneys establishing a blood draw/iv site would go a long way in preserving future access sites and make the process less scary for the people who are ill. My mom had to have many blood draws over her 3+ weeks stays and they were a big deal ... dreaded and painful.

Is this crazy or should people facing blood draw intensive hospitalizations have a graph placed?