[Evaluation via ecocolordoppler before creating a vascular access for hemodyalisis: a monocentric experience].

The use of a preoperative echocolordoppler improves the clinical evaluation because provides anatomical and hemodynamic information that make it an important tool in planning vascular access strategy. The preoperative ultrasound study of the vessels can significantly reduce the failure rate and the incidence of complications of vascular access. We describe the experience of our center, lasting 10-year, where the ultrasound assessment was performed in all patients before the creation of vascular access. Indeed, ultrasound reduces the rate of fistula failure and increases the utilization of fistula, allowing proper selection of vessels. In addition, the presence of the vascular access team has allowed us to achieve quite satisfactory results.

[Peripheral hypoperfusion syndrome and monomielic syndrome: from diagnosis to treatment. Case report with review of the literature].

Arteriovenous access ischemic steal is a fairly uncommon complication associated with the creation of a vascular access for hemodialysis, which can sometimes cause potentially devastating complications, with permanent disability. Several old names for this syndrome have now been replaced by two new denominations: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and Distal Hypoperfusion Ischemic Syndrome (DHIS). Clinically, we distinguish between the Peripheral Hypoperfusion Syndrome, which can cause gangrene of the fingers, and the Monomelic Syndrome, characterized by low incidence and by the presence of neurological dysfunctions. Risk factors include diabetes mellitus, atherosclerotic vascular disease, old age, female gender, tobacco use and hypertension. We report the case of a patient with HAIDI in order to increase awareness on this syndrome's early diagnosis and proper management. After describing the case, we also include a literature review.

[Retroperitoneal renal hemorrhage: experience of our dialysis center].

The aging of the uremic population, the increasingly common use of anticoagulants, antiplatelet agents e heparin, during hemodialysis, can expose our patients to a greatest risk of bleeding. Spontaneous retroperitoneal hematomas are a fairly rare and potentially fatal condition. We describe 5 clinical cases of retroperitoneal hemorrhage that we observed during 10 years in our department, focusing on modalities of symptom onset, clinical-laboratory picture and treatment modalities.

[Prevention of contrast-induced acute kidney injury]. / La prevenzione dell'insufficienza renale acuta da mezzo di contrasto.

Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute kidney injury in hospitalized patients. Its incidence depends on patient risk factors (chronic kidney disease, diabetes, cardiovascular diseases and older age) and procedure-related factors (high contrast dose, intraarterial administration). Chronic kidney disease, especially if associated with diabetes, is the main risk factor for CIN. Hydration before and after contrast administration is the only preventive therapy that is strongly recommended by guidelines in patients at risk. CIN prevention studies have focused mainly on cardiac patients with a moderate renal risk (GFR 60-40 mL/min) who underwent intraarterial contrast administration. Many clinical trials have evaluated the efficacy of hydration associated with sodium bicarbonate and of N-acetylcysteine (NAC) in CIN prevention. Sodium bicarbonate infusion has shown better efficacy than saline infusion, particularly when short infusion times are needed, such as in emergency procedures. NAC has not shown any clear effect, and some positive study results have not been confirmed in other trials. The discussion is still open on the efficacy of renal replacement therapies for the prevention of CIN in individuals at high renal risk (GFR <30 mL/min), in whom CIN could mark the entrance to chronic dialysis.

Effectiveness of a protocol for the prevention of hemodialysis venous catheter-related infections.

PURPOSE: Infections are a major complication of the use of hemodialysis central venous catheters. In our study we evaluated the efficacy of the hemodialysis central venous catheter protocol management adopted in our center, through a retrospective analysis of all hemodialysis central venous catheters inserted over a period of 6 years. METHODS: Seventy-three tunneled central venous catheters and 75 temporary central venous catheters were inserted in our center from 2003 to 2008 in 148 patients. RESULTS: During the follow-up we observed 30 infective events (16 assessed as bacteremias, 14 subcutaneous tunnel or exit site infections) with a rate of 0.65/1,000 days of central venous catheter implantation. CONCLUSIONS: Our experience confirms, in a 72-month follow-up, the importance of careful central venous catheter management as a crucial feature in reducing the incidence of infective events in patients with central venous catheters in dialytic treatment.