Higher Death Rates Seen in Central Line Dialysis Patients: Study

Doctors Lounge (http://www.doctorslounge.com/index.php/news/hd/19539)

Randy Dotinga HealthDay Reporter

THURSDAY, April 21 (HealthDay News) -- Doctors should avoid delivering hemodialysis to kidney failure patients through a central line catheter because that method is associated with a higher risk of death shortly after beginning dialysis, a new study contends.

Researchers examined the medical records of more than 38,500 Canadian patients who began dialysis from 2001-08. Patients who received hemodialysis through a central line catheter into a large vein had an 80 percent higher risk of death in the first year after starting dialysis than patients who received:

• Peritoneal dialysis (through a tube into the abdomen).
• Dialysis through an arteriovenous fistula (in which a surgeon connects an artery directly to a vein).
• Dialysis through an arteriovenous graft (in which a surgeon connects an artery to a vein with a synthetic tube, or graft, implanted under the skin in one arm).

Both the surgically created fistula and graft access sites are at less risk of infection than a central line, with a fistula least likely to become infected, the study authors said. Among central line patients, the risk of death was 20 percent higher five years after dialysis began than in the others. "Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our [hemodialysis] patients," Dr. Jeffrey Perl, of St. Michael's Hospital in Toronto, said in an American Society of Nephrology news release.

The researchers cautioned that the study was observational, not a randomized controlled trial, and that there was no information on the reasons why patients started dialysis with a central catheter vs. the other methods.

The study appeared in the Journal of the American Society of Nephrology.

In the study, about 63 percent of the patients received hemodialysis using a central line catheter, 17 percent began the treatment with an arteriovenous fistula or graft, and 19 percent performed peritoneal dialysis on themselves at home.

Those who got treatment through an arteriovenous fistula or graft when starting hemodialysis survived at about the same rate as those on dialysis through a tube in the abdomen.

Prior research has also suggested that peritoneal patients have a lower risk of death, Perl said.

Wishing all our 

Christian Brothers and Sisters

A Blessed & Sacred Good Friday

(Remembrance and Appreciation)

Warmest Regards and Best Wishes

Malaysian KidneySPA

Effects of Different Levels of Endotoxin Contamination on Inflammatory Cytokine Production by Peripheral Blood Mononuclear Cells after High-Flux Hemodialysis

Article contributed by Mr CS Choong  

Kearkiat Praditpornsilpa^a, Khajohn Tiranathanagul^a, Paweena Susantitaphong^a, Pisut Katavetin^a, Thananda Trakarnvanich^b, Natavudh Townamchai^a, Talerngsak Kanjanabuch^a, Yingyos Avihingsanon^a, Kriang Tungsanga^a, Somchai Eiam-Ong<sup>a

a</sup>Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and
^bRenal Unit, Department of Medicine, Bangkok Metropolitan Administration Medical College, Bangkok, Thailand

Blood Purif 2011;32:112-116 (DOI: 10.1159/000324394)


Abstract    

                                                                                             

Background: 
In Thailand, dialysate endotoxin contamination levels vary from less than 0.001 to 2.0 EU/ml. This difference has prompted an investigation on the production of proinflammatory cytokines and counter inflammatory mediators of peripheral blood mononuclear cells (PBMCs) after high-flux dialysis.                                                                                
                                                                                                   
Methods: 
Patients from four hemodialysis (HD) centers who met the inclusion/exclusion criteria were enrolled into the study. PBMCs were isolated by Ficoll density gradient centrifugation and cultured. Supernatants were tested for interleukin 6 (IL-6), IL-1β and IL-1 receptor antagonist (IL-1Ra) concentration by ELISA.                                                                   
                                                                                                   
Results: 
HD centers 1, 2, 3 and 4 had mean dialysate endotoxin contamination levels of 0.001, 0.026, 0.558 and 1.960 EU/ml, respectively. HD center 4 had the highest levels of IL-6 (1,052.3 ± 240.7 pg/106 PBMCs), IL-1β (1,297.1 ± 334.6 pg/106 PBMCs) and IL-1Ra (2,713.4 ± 1,255.3 pg/106 PBMCs). There were no significant differences in cytokine production between HD centers 1 and 2.                                                                       
                                                                                                   
Conclusion:  
Our study showed that ultrapure dialysate can minimize the risk of stimulating inflammatory cells. Ultrapure dialysate may prevent or delay endotoxin exposure-related complications. 

Wishing all our

Hindu Brothers and Sisters

A Happy and Blessed 

Vaisakhi

"We can never live in this world alone"

Warmest Regards and Best Wishes,

Malaysian KidneySpa

Solve the shortages before going strictly by the book

Letter by SS Lim PJ, The Star Online, 14th April 2011

I REFER to “Relief for kidney patients” (The Star, April 13). The comments made by the director-general of health are indeed welcome news for dialysis patients, and the positive tone shows clear willingness to respond to the concerns of the interested parties, especially the patients.

However, allow me to add some perspective to three critical issues.

The requirement for a resident or visiting nephrologist remains a major obstacle to licensing. As the director-general of health noted, there are 618 dialysis units in Malaysia (437 non-government and 181 public dialysis centres), but only about 100 nephrologists.

The mathematics shows that it is difficult for non-government dialysis centres to engage the services of a nephrologist. The Health Ministry needs to address this issue before making it a strict requirement.

Perhaps foreign nephrologists can be allowed to practise in Malaysia while efforts are made to increase the number of doctors being trained in nephrology.

Read letter in full here

D-G: No plans to close down 437 private haemodialysis centres

By LESTER KONG
lester@thestar.com.my , 13th April 2011

PUTRAJAYA: The Government has no intention of closing down the 437 non-government haemodialysis centres nationwide, said health director-general Datuk Dr Hasan Abdul Rahman.

He said the service provided by the centres was much needed as there were only 181 public haemodialysis centres.

Dr Hasan said the non-government centres were safe if they complied with the minimum criteria set by the ministry and obtained their operating licences.

Non-government centres nationwide care for 16,307 patients while government centres treat 7,115 patients.

“Even if they can't comply by getting the necessary training for their doctors, nurses and medical assistants, we will still work out a timeframe for them to relocate their patients,” he said yesterday.

It was reported that five Health Ministry officials visited the Pertubuhan Hemodialysis Seberang Perai Selatan in Simpang Ampat, Nibong Tebal, and ordered it to shut down by May 1 as it did not have a full-time nephrologist.

Read full text here

Al-Fatihah

Our Deepest and Heartfelf Condolences to

the family of the late

Ahmad Sarbani Bin Mohamed

(A humble man with a great heart)

on his untimely demise

"May his soul be blessed and rest in peace"

 A Friend and Comrade in Dialysis

Batch 25 (Seremban)