Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.

BACKGROUND: Removal of tunneled dialysis catheters (TDC) usually occurs in dedicated procedure suites and is performed relatively rarely at the bedside. Scarce evidence exists in the literature to assess the safety and success of this procedure when performed during supervised academic training. PATIENTS AND METHODS: We conducted a retrospective chart review of all TDC removals performed on an outpatient basis by nephrology fellows under faculty supervision during a 5-year period at an academic Veterans Affairs Medical Center. Data were collected regarding patient demographics, basic laboratory studies, pertinent clinical information and procedure-related variables. We evaluated the safety, success and complication rate of this procedure. RESULTS: We identified 72 TDC removals that met the above criteria. Mean age was 63 ± 10 years. All patients were male and hypertensive, 68% were diabetic and 69% were African-American. Overall, 88% of procedures were performed in end-stage renal disease (ESRD) patients, while the rest had needed temporary dialysis for acute kidney injury. Notably, 49 patients (68%) were taking one or more of aspirin, clopidogrel or warfarin at the time of TDC removal. Overall complication rate was low (<2%). There was no increase in risk of bleeding, even in subjects receiving anti-platelet therapy; only one of the 49 patients (2%) had a minor bleeding complication. CONCLUSIONS: Outpatient TDC removal by trainees was successful and safe in the vast majority of cases (99%). We propose that TDC removal skills should be actively pursued and acquired by all nephrology fellows. This would expand the scope of practice for future general nephrologists and facilitate timely patient care.

Orlistat-induced oxalate nephropathy may be dose-independent and present as a late manifestation.

We present the case of a 61-year-old Caucasian male veteran who had been on orlistat (120mg dosing) for four years, and had changed to the over-the-counter (OTC) form, Alli (orlistat 60mg), about three months before presentation. He had been experiencing nausea and vomiting for three weeks prior to evaluation. Laboratory studies revealed a serum creatinine of 6.2 mg/dL--his previous renal function having been normal. An ultrasound-guided renal biopsy was performed, which revealed deposition of calcium oxalate crystals in the renal tubules. Orlistat is a popular weight-loss medication. Orlistat-induced oxalate crystal nephropathy has recently been reported in the literature, resulting from the original, patented version. We report a case with the first such complication from the OTC version, Alli - which is a reduced-dose formulation. Our case report highlights that this complication can occur after several years of use of the medication and is not necessarily dose dependant.