ABSTRACT
PURPOSE: The prevalence of haemodialysis is increasing globally. There is a consensus of international opinion that permanent vascular access is preferred for haemodialysis. Patients with end-stage renal disease carry a high burden of cardiovascular comorbidity. There is a lack of data to quantify the post-operative risk of vascular access surgery. This study looked to establish the 30-day post-operative mortality for patients undergoing surgery to create vascular access and to measure for differences between the types of access created and the mode of anaesthesia. METHODS: We conducted a retrospective study of all cases over a 5-year period at a tertiary renal unit in the UK. Data recorded included co-morbidity, time on renal replacement therapy, type of access created, mode of anaesthesia and 30-day mortality. The incident risk was calculated and logistic regression used to calculate the adjusted odds ratio. RESULTS: A total of 1404 operations were included. 30-day mortality for the whole cohort was 1.1% (16/1404). The adjusted odds ratio of death at 30 days using an upper limb fistula as a reference was 5.27 for an upper limb graft (p = 0.005) and 11.51 (p = 0.007) for any lower limb access. Using local anaesthesia as a reference the adjusted odds ratio for surgery under general anaesthesia was 6.28 (p = 0.001). CONCLUSIONS: Vascular surgery for haemodialysis is associated with significant and variable post-operative mortality; this study highlights the need for careful pre-operative planning in this complex group of patients.
Subject(s)
Arteriovenous Shunt, Surgical/mortality , Kidney Failure, Chronic/therapy , Renal Dialysis , Upper Extremity/blood supply , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, General/adverse effects , Anesthesia, Local/adverse effects , Arteriovenous Shunt, Surgical/adverse effects , Comorbidity , Databases, Factual , England , Female , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/mortality , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Renal Dialysis/adverse effects , Renal Dialysis/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Tertiary Care Centers , Time Factors , Treatment Outcome , Young AdultSubject(s)
Kidney Transplantation/methods , Photography , Humans , Pilot Projects , Surveys and Questionnaires , United KingdomABSTRACT
BACKGROUND: Within the field of renal transplantation there is a lack of qualified and trainee surgeons and a shortage of donated organs. Any steps to tackle these issues should, in part, be aimed at future doctors. METHODS: A questionnaire was distributed to final year students at a single medical school in the UK to assess their exposure to and knowledge of renal transplantation. RESULTS: Although 46% of responding students had examined a transplant recipient, only 14% had ever witnessed the surgery. Worryingly, 9% of students believed that xenotransplantation commonly occurs in the UK and 35% were unable to name a single drug that a recipient may need to take. CONCLUSIONS: This survey demonstrates a lack of exposure to, and knowledge of, the field of renal transplantation. Recommendations to address the problems with the recruitment of surgeons and donation of organs, by targeting medical students are made.
Subject(s)
Clinical Competence/statistics & numerical data , Kidney Transplantation/education , Specialties, Surgical/education , Students, Medical/statistics & numerical data , Adult , Chi-Square Distribution , Data Collection , Health Services Needs and Demand/trends , Humans , Immunosuppressive Agents , Kidney Transplantation/immunology , Kidney Transplantation/methods , Population Dynamics , Surveys and Questionnaires , Tissue Donors , Tissue and Organ Procurement , United Kingdom , WorkforceABSTRACT
Antineutrophil cytoplasmic antibody-associated vasculitides often cause small-vessel vasculitis, usually involving the kidney. Involvement of other organ systems and medium to large arteries is recognized, but free-vessel rupture is rare. A case of a man with classic renal involvement caused by microscopic polyangiitis associated with multiple episodes of hemoperitoneum secondary to splanchnic vasculitis is described. Although his renal vasculitis responded to conventional immunosuppressive treatment, relentless progression of splanchnic vasculitis ultimately proved fatal.
