Vascular access interventional therapy of early arteriovenous fistula occlusion leading to long-term patency: A case report.

Arteriovenous fistulas (AVFs) are frequently used for hemodialysis access, but approximately 15%-20% of AVFs fail to mature within 3 months of their creation. Vascular access interventional therapy (VAIVT) is typically performed for treating an immature AVF. However, it should be performed 4-6 weeks or later after AVF creation. Here, we present a case in which VAIVT effectively addressed AVF occlusion that occurred only 9 days after its creation. The patient was an 82-year-old woman with chronic kidney disease who underwent surgery to create a left radiocephalic AVF for hemodialysis. Nine days postoperatively, disappearance of the AVF sound prompted an angiography, revealing thrombosis near the AVF anastomosis. VAIVT successfully restored blood flow, resulting in AVF maturation, and with no thrombosis or flow dysfunction at 21 months after VAIVT. To the best of our knowledge, this case presents the earliest successful intervention for an occluded AVF.

Efficacy of On-line Hemodiafiltration for Rhabdomyolysis Presenting with Acute Kidney Injury Due to Unexpected Drug Abuse.

Myoglobin is a well-known cause of acute kidney injury (AKI) due to rhabdomyolysis. However, whether or not removing serum myoglobin by on-line hemodiafiltration (OHDF) improves the kidney function remains unclear. We herein report a patient with a history of methamphetamine abuse who developed AKI due to rhabdomyolysis. A urinalysis and blood collection results obtained before and after OHDF demonstrated that OHDF improved the kidney function by removing a large amount of serum myoglobin rather than via urinary excretion. In conclusion, OHDF may prevent AKI progression effectively when the urine volume is insufficient.

The association between body mass index and all-cause mortality in Japanese patients with incident hemodialysis.

BACKGROUND: A higher body mass index (BMI) has been associated with better survival among chronic kidney disease patients in some reports. However, more research is required to determine the associations between BMI and mortality in incident hemodialysis patients. Therefore, this study aimed to investigate the association between mortality and BMI measured at the first hemodialysis session and 2 weeks after hemodialysis initiation in Japanese patients with incident hemodialysis. METHODS: We retrospectively enrolled 266 adult patients with incident hemodialysis who were treated at our hospital between May 2013 and June 2019. The data on BMI was obtained at the first hemodialysis session and 2 weeks after hemodialysis initiation. Patients were divided into tertiles based on BMI [<18.5 (low), 18.5-23.9 (normal), and ≥24 (high) kg/m2]. The normal group was used as the reference group. The primary outcome was all-cause mortality. RESULTS: The mean age of patient was 68.9 ± 12.0 years, and the BMI was 23.3 ± 4.24 kg/m2 at the first hemodialysis session. The body mass index was 22.0 ± 3.80 kg/m2 at 2 weeks after hemodialysis initiation. During a mean follow-up of 3.89 ± 2.12 years, 80 (30.1%) deaths occurred. In multivariate analyses, low BMI at the first hemodialysis session was significantly associated with worse all-cause mortality (hazard ratio, 2.39; 95% confidence interval, 1.13-5.03). At 2 weeks after hemodialysis initiation, high BMI was significantly associated with better all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81). CONCLUSION: At 2 weeks after HD initiation, high BMI was associated with lower mortality in Japanese patients with incident hemodialysis.