Subject(s)
Antipsychotic Agents/adverse effects , Coronavirus Infections/complications , Haloperidol/analogs & derivatives , Neuroleptic Malignant Syndrome/etiology , Pneumonia, Viral/complications , Schizophrenia/drug therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Betacoronavirus , Bromocriptine/therapeutic use , C-Reactive Protein/immunology , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Dantrolene/therapeutic use , Dopamine Agonists/therapeutic use , Enzyme Inhibitors/therapeutic use , Haloperidol/adverse effects , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , Leukocytosis , Lymphopenia , Male , Middle Aged , Muscle Relaxants, Central/therapeutic use , Neuroleptic Malignant Syndrome/physiopathology , Neuroleptic Malignant Syndrome/therapy , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Renal Dialysis , Respiration, Artificial , Rhabdomyolysis/etiology , Rhabdomyolysis/therapy , SARS-CoV-2 , Schizophrenia/complicationsABSTRACT
Cephalic arch stenosis is a common complication in maintenance hemodialysis (MHD) patients with brachial artery-cephalic vein fistulas and frequently leads to loss of the functioning brachial artery-cephalic vein fistula. There is paucity of conclusive data to guide appropriate management. We examined the risk of recurrence of cephalic arch stenosis after angioplasty compared to angioplasty after stent placement determined by angiography of the involved upper extremity over time in a contemporary cohort of MHD patients treated in two interventional nephrology practices from March 2008 through May 2011. We retrospectively identified 45 MHD patients with evidence of cephalic arch stenosis (age 60 ± 30 years, 45% men) on elective angiograms. The median number of days until another angioplasty was required decreased, starting with a median of 91.5 days after the first, 70.5 days after the second, 85 days after the third, and 56 days after the fourth. Angioplasty is associated with a faster rate of recurrence of cephalic arch stenosis. The placement of intravascular stent seems to prolong the patency compared to angioplasty alone. Clinical trials with a larger sample size will better elucidate the value and timing of angioplasty versus stent placement in cephalic arch stenosis.
Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Brachial Artery , Brachiocephalic Veins , Graft Occlusion, Vascular/therapy , Renal Dialysis/adverse effects , Adult , Aged , Aged, 80 and over , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Female , Graft Occlusion, Vascular/diagnosis , Graft Occlusion, Vascular/etiology , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Retrospective Studies , Stents , Treatment Outcome , Vascular PatencyABSTRACT
Aggressive NIH is a common histopathological lesion found at the sites of venous stenosis in arteriovenous fistula (AVF) and arteriovenous grafts (AVG). Inflammatory mediators have been proposed to play a pathogenic role in NIH, but there is paucity of data evaluating this hypothesis in clinical studies or in animal models. Serum levels of inflammatory mediators can potentially identify patients at high risk of AVF and AVG dysfunction. In a cross-sectional cohort study of 754 HD patients who were part of the NIED study cohort, we examined the associations between inflammatory markers including serum interleukin (IL) 1ß, IL-6, C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) and type of vascular access. Unadjusted and multivariate-adjusted linear regression models were used. In addition, time-dependent regression model was used to assess the association between inflammatory markers and mortality. We observed that in the multivariate-adjusted model, inflammatory mediators interleukin-6 (IL-6), interleukin-1L-ß (IL-1ß), and C-reactive protein (CRP), the predicted value in hemodialysis patients, are lowest in patients with AVF and highest in central venous catheter (CVC) and AVG even in case-mix and malnutrition-inflammation complex syndrome (MICS)-adjusted models. IL-6 and CRP levels fall consistently in the same patients when AVG or CVC is changed to AVF and increase if the same patient changes access from AVF to AVG or CVC. Obesity is a risk factor for fistula failure and fistulas are associated with the lowest mortality compared with CVC and AVG. We did not find any statistically significant association between tumor necrosis factor-α (TNF- α) and vascular access outcomes. Higher levels of inflammatory mediators seen in CVC and AVG compared with AVF could potentially explain the higher mortality seen in patients with CVC and AVG compared with AVF.
