ABSTRACT
Background: Inadequate vascular access in patients on haemodialysis is a major cause of hospitalization leading to life threatening complications. This study evaluated the types of vascular access, location and associated complications in patients with chronic kidney disease (CKD) on haemodialysis.Methods: Patients with CKD stage V on haemodialysis were included in the study. The data was retrospectively collected including demographic details, comorbidities, serum creatinine, haemoglobin, type and site of access and associated complications.Results: A total of 82 patients with mean (SD) age of 56.6(13.9) years were included with 50 (60.9%) patients on arteriovenous fistula (AVF) access and remaining 32 (39.1%) on dual-lumen catheter (DLC). Hypertension (42.6%) was the most common comorbidity reported followed by diabetes (24.3%) and chronic glomerulonephritis (13.4%). In AVF access, 25 (50.0%) had wrist as site of access, 10 (20.0%) had forearm, 11(22.0%) had brachiocephalic and four (8.0%) brachiobasilic. Of 32 DLC access, 27(84.4%) had jugular vein and four (12.5%) femoral vein. One patient with AVF access reported venous hypertension; however, the complications reported in patients with DLC access were infection (n=6, 18.8%) and hematoma and venous hypertension (n=1, 3.7%, each).Conclusions: This study with limited sample size showed that the most common access site for AVF and DLC was wrist and jugular vein, respectively. Infection was the most common complication in patients with DLC. AVF is comparatively safe option for haemodialysis; however, DLC should be used only as a temporary option.
ABSTRACT
Immunofluorescence (IF) studies are important diagnostic tool in understanding pathogenesis involved in graft injury. Acute humoral rejection (AHR) associated with circulating donor-specific cytotoxic antibodies, is a poor prognosticator for graft survival. It can be diagnosed by staining for C4d antibody using indirect IF technique. C4d staining required to diagnose AHR was made mandatory for reporting renal allograft biopsies in 7th Banff conference. We present 2 years experience of IF studies using C4d polyclonal antibody on 546 renal allograft biopsies belonging to two groups of patients; 464 from group A (tolerance induction protocol) and 82 from group B (controls). We observed C4d focal positivity in 4 (0.9%) biopsies from group A and 4 (4.9%) from group B. We conclude that it is advisable to collect simultaneous core biopsy samples for IF studies and light microscopy to give better definition of allograft injury and thereby support in clinical management.