1
|
Idrees N, Haroon S, Zhang Y, Mangio JC, Siracuse JJ, Francis JM, Ganguli S, Daly K, Diamond M, Vilvendhan R, Cabral H, Dember LM, Farber A, Kolachalama VB, Chitalia VC. Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction. Kidney Int Rep 2023; 8:1887-1891. [PMID: 37705907 PMCID: PMC10496077 DOI: 10.1016/j.ekir.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Najia Idrees
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
| | - Samir Haroon
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yichi Zhang
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Joanna Crisa Mangio
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jean M. Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Suvranu Ganguli
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Daly
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Diamond
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rajendran Vilvendhan
- Department of Radiology, Interventional Radiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Laura M. Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics, Epidemiology and Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B. Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| |
Collapse
|
2
|
Wilson E, Sacknovitz Y, Dalmia V, Sanon O, Hatch A, Dauer M, Scher L, Lipsitz E, Koleilat I. Initiation of hemodialysis at one month following fistulogram in patients with advanced kidney disease. Vascular 2023; 31:387-391. [PMID: 34994670 DOI: 10.1177/17085381211068231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD. METHODS A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. RESULTS A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue (p = .005) and elevated contrast volume, with a mean of 40 mL (p = .027). CONCLUSION Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.
Collapse
Affiliation(s)
- Eelin Wilson
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yoni Sacknovitz
- Department of Biology, 2007Yeshiva University, New York, NY, USA
| | - Varun Dalmia
- Department of Cardiothoracic and Vascular Surgery, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Omar Sanon
- Division of Vascular Surgery2613, Northwell Health - Lenox Hill Hospital, New York, NY, USA
| | - Ayesha Hatch
- Department of Vascular Surgery, 2613Medstar Washington Hospital Center, Washington, DC, USA
| | - Marc Dauer
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Larry Scher
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Evan Lipsitz
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Issam Koleilat
- Department of Surgery, Community Medical Center, 4598RWJ/Barnabas Health, Tom's River, NJ, USA
| |
Collapse
|
3
|
Grist TM, Canon CL, Fishman EK, Kohi MP, Mossa-Basha M. Short-, Mid-, and Long-Term Strategies to Manage the Shortage of Iohexol. Radiology 2022; 304:289-293. [PMID: 35587228 DOI: 10.1148/radiol.221183] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent disruptions in a pharmaceutical supply chain critical to radiologic imaging has impacted the global availability of iohexol iodinated contrast media (ICM). The shortage of iohexol has created a national crisis in the ability of radiology departments to provide health care to patients needing contrast-enhanced exams. Radiology departments are familiar with crisis management after more than two years of clinical and operational disruptions associated with the COVID-19 pandemic. The implications of this shortage has near-term (weeks), mid-term (months), and long term (years) impact. The purpose of this report is to provide the reader with strategies for dealing with the shortage of ICM in the near term and discuss long-term issues and potential solutions to supply chain problems impacting radiology departments.
Collapse
Affiliation(s)
- Thomas M Grist
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Astor BC, Hirschman K, Kennedy J, Frinak S, Besarab A. Development and validation of a risk score to prioritize patients for evaluation of access stenosis. Semin Dial 2021; 35:236-244. [PMID: 34642963 PMCID: PMC9292738 DOI: 10.1111/sdi.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
Background Access flow dysfunction, often associated with stenosis, is a common problem in hemodialysis access and may result in progression to thrombosis. Timely identification of accesses in need of evaluation is critical to preserving a functioning access. We hypothesized that a risk score using measurements obtained from the Vasc‐Alert surveillance device could be used to predict subsequent interventions. Methods Measurement of five factors over the preceding 28 days from 1.46 million hemodialysis treatments (6163 patients) were used to develop a score associated with interventions over the subsequent 60 days. The score was validated in a separate dataset of 298,620 treatments (2641 patients). Results Interventions in arteriovenous fistulae (AVF; n = 4125) were much more common in those with the highest score (36.2%) than in those with the lowest score (11.0). The score also was strongly associated with interventions in patients with an arteriovenous graft (AVG; n = 2,038; 43.2% vs. 21.1%). There was excellent agreement in the Validation datasets for AVF (OR = 2.67 comparing the highest to lowest score) and good agreement for AVG (OR = 1.92). Conclusions This simple risk score based on surveillance data may be useful for prioritizing patients for physical examination and potentially early referral for intervention.
Collapse
Affiliation(s)
- Brad C Astor
- Department of Medicine, Division of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - Stan Frinak
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan, USA
| | - Anatole Besarab
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|