Wishing All

Our Muslim Brothers and Sisters

A Selamat Hari Raya Adil Adha

(May all your scarifices be blessed)

Best Wishes & Warmest Regards

Malaysian KidneySPA

The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure.

Kim WS, Pyun WB, Kang BC.

Source

Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea.

PMID:

22022326 PubMed - in process] 

PMCID: PMC3193042

Abstract

BACKGROUND AND OBJECTIVES:

Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients.

SUBJECTS AND METHODS: We performed 231 interventions in 118 patients with a mean age of 62.1±12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred.

RESULTS:

For the 118 patients, the median patency time was 10.45±10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically.

CONCLUSION:

PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.

Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality

Jennifer E. Flythe,¹ Stephen E. Kimmel,² and Steven M. Brunelli¹

¹Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

²Cardiology Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

PruMed Central: PMCID: PMC3091945

Abstract

Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10–13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10–13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.

Read full article here

Wishing All Our 

Hindu Brothers & Sisters

A Happy and Blessed Diwali

May the "True Light" prevail

Best and Warmest Regards

MalaysianKidneySPA

Inform family about pledges, organ donors told

The Star Online 24/10/2011

http://thestar.com.my/news/story.asp?file=/2011/10/24/nation/9760649&sec=nation

KUALA LUMPUR: Those who have pledged to be organ and tissue donors should inform their families to avoid “complications”.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that in most cases, family members of the deceased did not know of the pledge made.

“If they do not inform their next-of-kin, no one will know about it. If the family does not allow it, there is nothing that can be done,” she told reporters after launching the Bicara Hati programme in conjunction with Organ Donation Awareness Week 2011.

To create more awareness, she said the ministry had stepped up its campaigns and held forums, debates and health workshops through the “Young Doctors” programme.

Rosnah said donors should be hailed as community heroes and for upholding the 1Malaysia spirit.

She also paid tribute to family members who consented to the organ pledges.

Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group

1. Stephen P. McAdoo1, 
2. Edwina A. Brown1, 
3. Alistair M. Chesser2 
4. Ken Farrington3,
5. Emma M. Salisbury1 and 
6. on behalf of pan-Thames renal audit group

1. 1. ¹Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK
   2. ²Renal Department, Barts and the London NHS Trust, London, UK
   3. ³Lister Hospital Renal Unit, North Herts NHS Trust, Stevenage, UK
   Background. Despite a recent increased awareness of the need for quality End of Life (EOL) care for patients with advanced kidney disease, there is no established method for measuring or auditing outcomes relating to EOL care in this population.

   Methods. We designed a one-page proforma, which was used to collect data on various aspects of EOL care relating to all deaths of patients on dialysis and patients dying on specialist renal wards, over a predefined 8-week period in 10 hospitals in London and South–East England.

   Results. One hundred and thirty-eight deaths were recorded over the 8-week study period. The majority of patients (83%) were receiving maintenance haemodialysis prior to their terminal presentation. About 69% of deaths occurred during an in-patient hospital admission—of these, 36% were considered ‘unexpected’ and most quality markers of good EOL management were significantly less likely to be achieved in these patients, including use of palliative care strategies, good symptom control and overall quality of death. Thirty-six per cent of patients were from various ethnic minorities, and in this group, there was a trend towards lower use of palliative care pathways and lower rates of withdrawal from dialysis.

   Conclusions. This study confirms that it is possible to measure many important outcomes relating to quality of EOL care using a proforma completed at the time of death. Our findings suggest that many aspects of good EOL care are under-achieved in our region. This, in part, is due to a failure to recognize the worsening trajectory of the deteriorating patient, resulting in missed opportunities for EOL care planning and appropriate symptom control. Our observations suggest that there is a need for improved education and training in this area, particularly in detection of the dying patient, the value of advance care planning and the utility of tools such as the Liverpool Care Pathway.

No meds for unapproved ops

By WONG PEK MEI
pekmei@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2011/10/17/nation/9711992&sec=nation

BANGI: Malaysians who travel abroad for organ transplants provided on commercial basis will not be allowed to get free supply of immunosuppressant drugs from Government hospitals, which costs between RM800 and RM1,000 per patient per month.

These drugs are used to inhibit or prevent activity of the immune system and to prevent the rejection of transplanted organs and tissues.

Health Minister Datuk Seri Liow Tiong Lai said the move, which takes effect from January, is to stop people from going overseas to get such treatment from unrecognised hospitals without the ministry's approval or knowledge.

He said many patients go for organ transplants at hospitals in foreign countries that are not recognised.

Read full article here