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Zhang J, Nie Q, Xu X, He B, Wang X, Wang F, Liu P, Fan X, Ye Z. A novel extra-catheter guide wire technique for in situ exchange of dysfunctional tunnelled central venous hemodialysis catheter. J Vasc Access 2024; 25:94-99. [PMID: 35578550 DOI: 10.1177/11297298221096520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tunneled central venous catheters (tCVC) exchange may be difficult in some situations. We retrospectively report our preliminary experience of a novel extra-catheter guide wire technique for exchange of dysfunctional tCVC. MATERIALS AND METHODS Retrospectively analyze the demographics, treatment details and outcomes data of 39 patients received tCVC exchange from January 2018 to January 2019. According to whether guide wire could pass through the catheter lumen, patients were divided into in-catheter group and extra-catheter group. The technical successful rate, peri-operative complications, 1-month and 6-month catheter flow rate was recorded and compared between the 2 groups. RESULTS The final study population consists of 39 patients, including 16 in-catheter group and 23 extra-catheter group. The technical successful rate was 100% in both groups. All patients achieved restoration of line patency and completed at least 1 hemodialysis section. The 1-month (267.69 ± 20.12 vs. 274.13 ± 17.69, p = 0.604) and 6-month (255.81 ± 12.93 vs. 256.97 ± 11.20, p = 0.403) catheter flow rate was comparable between the 2 groups. CONCLUSION The novel extra-catheter guide wire technique was helpful for in situ exchange of dysfunctional tunneled central venous hemodialysis catheters, especially when the guide wire could not pass through the catheter lumen.
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Affiliation(s)
- Jianbin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiangqiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojie Xu
- Department of Endocrinology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xuming Wang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Feng Wang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Kim SY, Aryal S, Yun WS, Kim WC, Moon SB, Chae GB, Key J, Kim S. Histologic evaluation of a catheter coated with paclitaxel PLGA nanoparticles in the internal jugular veins of rats. Biomed Eng Lett 2023; 13:505-514. [PMID: 37519876 PMCID: PMC10382362 DOI: 10.1007/s13534-023-00282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 08/01/2023] Open
Abstract
The aim of this study is to investigate the potential impact of catheterization on intimal hyperplasia and explore the efficacy of Paclitaxel loaded PLGA nanoparticles (PTX-NPs) in preventing stenosis at the site of venous injury. Under general anesthesia, Central Venous Catheters were inserted into the rat's right internal jugular veins (IJV) using the cut-down technique. Twenty bare catheters (C) and twenty PTX-NPs coated catheters (P) were assigned to one of four groups (C2, C4, P2, or P4) based on catheter type and expected survival time. 2 or 4 weeks after surgery, IJVs were completely harvested by formalin fixation and gelatin infusion and slides were stained with H&E (Haematoxylin and Eosin) and Masson's technique. The P2 (Paclitaxel coating, 2 weeks) group showed the most proliferation among the four groups and the P4 (Paclitaxel coating, 4 weeks) showed a tendency to decrease proliferation. Additionally, the lumen size in the P4 group was about 6% smaller than in the P2 group, and there was a lower prevalence of stenotic grade in the P4 group. Our study suggests that PTX-NPs coated catheters may be effective in preventing venous stenosis if the intended usage is prolonged, rather than for a short-term period. Graphical abstract Schematic representation of catheter functionalization and coating of PTX-NPs on Catheter. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-023-00282-y.
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Affiliation(s)
- Song-Yi Kim
- Department of Surgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Susmita Aryal
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Wan Su Yun
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Woo Cheol Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Suk-bae Moon
- Department of Surgery, College of Medicine, Kangwon National University, Chun-Cheon, Korea
| | - Gi-bong Chae
- Department of Surgery, College of Medicine, Kangwon National University, Chun-Cheon, Korea
| | - Jaehong Key
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Seongyup Kim
- Department of Surgery, College of Medicine, Yonsei University, Wonju, Korea
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Wang L, Jia L, Jiang A. Pathology of catheter-related complications: what we need to know and what should be discovered. J Int Med Res 2022; 50:3000605221127890. [PMID: 36268763 PMCID: PMC9597033 DOI: 10.1177/03000605221127890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important access modality and used in a high percentage of the hemodialysis population. However, because of the conundrum posed by tunneled cuffed catheters, patients can develop a multitude of complications, including thrombosis, infections, formation of a fibrin sheath, and central vein stenosis, resulting in increased morbidity and mortality as well as placing a heavy burden on the healthcare system. However, with an increasing number of studies now focusing on how to manage these catheter-related complications, there has been less translational research on the pathology of these complications. This review of the most recent literature provides an update on the pathological aspects of catheter-related complications, highlighting what we need to know and what is yet to be discovered. The future research strategies and innovations needed to prevent these complications are also addressed.
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Affiliation(s)
- Lihua Wang
- Lihua Wang, Department of Kidney Disease
and Blood Purification Centre, 2nd Hospital of Tianjin Medical University, 23rd
Pingjiang Road, Hexi District, Tianjin 300211, PR China.
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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Lichtenstein T, Mammadov K, Rau K, Große Hokamp N, Do TD, Maintz D, Chang DH. Long-Term Follow-Up and Clinical Relevance of Incidental Findings of Fibrin Sheath and Thrombosis on Computed Tomography Scans of Cancer Patients with Port Catheters. Ther Clin Risk Manag 2021; 17:111-118. [PMID: 33536758 PMCID: PMC7850422 DOI: 10.2147/tcrm.s287544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose This retrospective study examined the incidence, progression, and clinical relevance of catheter-related thrombosis (CRT) and/or fibrin sheaths presenting as incidental findings on routine staging computed tomography (CT) scans performed in cancer patients. Patients and Methods Patients who underwent central venous port catheter (CVC) placement in a tertiary care hospital between September 2010 and August 2013 were followed up for up to five years. Two radiologists assessed the presence of fibrin sheath and thrombosis in consensus in staging CT scan. Patient demographics, type of cancer, preoperative comorbidities, date of CVC placement and CTs, preexisting anticoagulation, as well as the type and treatment of catheter-related complications were determined from the electronic medical record. Results A total of 194 patients with 530 CT scans and a mean follow-up time of 394 days were included. Fibrin sheaths and thromboses were seen on 46 scans (8.7%) in 30 patients and 80 scans (15.1%) in 35 patients. The incidence of fibrin sheaths and thromboses was found to be 15.5% and 18%, respectively. The comparison to initial CT reports results indicated that fibrin sheaths or thromboses were missed in 106 examinations (20%). Catheter-associated complications were reported in 14 patients (21.5%) without specific therapy. Conclusion Fibrin sheaths and CRTs are often overlooked on routine CT scans when patients are asymptomatic. The subsequent high complication rate demonstrates the clinical relevance of the initial incidental finding on CT scan. Further studies should elucidate the effect of thrombolytic agents and interventional radiologic treatment in asymptomatic patients.
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Affiliation(s)
| | - Kamal Mammadov
- Department of Radiology, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Karin Rau
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Thuy D Do
- Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - De-Hua Chang
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.,Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany
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Gan X, Zhao H, Wei Y, Jiang Q, Wen C, Ying Y. Role of miR-92a-3p, oxidative stress, and p38MAPK/NF-κB pathway in rats with central venous catheter related thrombosis. BMC Cardiovasc Disord 2020; 20:150. [PMID: 32228467 PMCID: PMC7106664 DOI: 10.1186/s12872-020-01436-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND miR-92a-3p and oxidative stress are reportedly associated with venous thrombosis. However, the role of miR-92a-3p and oxidative stress in catheter-related thrombosis (CRT) remains ambiguous. Herein, we studied the roles of miR-92a-3p, oxidative stress, and p38-mitogen-activated protein kinase/nuclear factor kappa-B (MAPK/NF-κB) pathway in CRT. METHODS Forty-five male rats were randomly and equally divided into control, sham operation, and CRT groups. The rats were sacrificed after 10 days. Reactive oxygen species (ROS), superoxide dismutase (SOD), and malondialdehyde (MDA) levels in the serum were determined by enzyme-linked immunosorbent assay (ELISA). The expression levels of miR-92a-3p, heme oxygenase-1 (HO-1), NF-κB p65, and p38 MAPK in the venous tissues were detected with quantitative polymerase chain reaction (qPCR) and Western blot. RESULTS Thrombosis was observed only in the CRT group. Compared with the levels in the control and sham operation groups, ROS and MDA significantly increased in the CRT group, but SOD significantly decreased. qPCR and Western blot results showed that miR-92a-3p, HO-1, p38 MAPK, and NF-κB p65 expression was significantly upregulated in the venous tissues of the CRT group. Moreover, miR-92a-3p was positively correlated with HO-1, which was positively correlated with p38 MAPK and NF-κB p65. CONCLUSION miR-92a-3p was correlated with oxidative stress in CRT. miR-92a-3p and oxidative stress contributed to endothelial dysfunction and simultaneously was associated with CRT.
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Affiliation(s)
- Xiao Gan
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Huihan Zhao
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Yan Wei
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Qingjuan Jiang
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Cui Wen
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Yanping Ying
- Department of Cardiothoracic surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China.
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Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches. COATINGS 2019. [DOI: 10.3390/coatings9080515] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rising rate of individuals with chronic kidney disease (CKD) and ineffective treatment methods for catheter-associated infections in dialysis patients has led to the need for a novel approach to the manufacturing of catheters. The current process requires moulding, which is time consuming, and coated catheters used currently increase the risk of bacterial resistance, toxicity, and added expense. Three-dimensional (3D) printing has gained a lot of attention in recent years and offers the opportunity to rapidly manufacture catheters, matched to patients through imaging and at a lower cost. Fused deposition modelling (FDM) in particular allows thermoplastic polymers to be printed into the desired devices from a model made using computer aided design (CAD). Limitations to FDM include the small range of thermoplastic polymers that are compatible with this form of printing and the high degradation temperature required for drugs to be extruded with the polymer. Hot-melt extrusion (HME) allows the potential for antimicrobial drugs to be added to the polymer to create catheters with antimicrobial activity, therefore being able to overcome the issue of increased rates of infection. This review will cover the area of dialysis and catheter-related infections, current manufacturing processes of catheters and methods to prevent infection, limitations of current processes of catheter manufacture, future directions into the manufacture of catheters, and how drugs can be incorporated into the polymers to help prevent infection.
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TuLIP (Tunnelled Line Intraluminal Plasty): An Alternative Technique for Salvaging Haemodialysis Catheter Patency in Fibrin Sheath Formation. Cardiovasc Intervent Radiol 2019; 42:770-774. [PMID: 30824945 PMCID: PMC6435624 DOI: 10.1007/s00270-019-02189-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/18/2019] [Indexed: 11/05/2022]
Abstract
Background Renal patients with a tunnelled haemodialysis line are at risk of fibrin ‘sheath’ formation which can lead to occlusion. Dysfunctional lines are best treated by catheter exchange with a new subcutaneous tunnel; however, there is a risk of scarring, venous stenosis, potential loss of valuable access as well as the risk of infection. Method We report a retrospective review of our experience using tunnelled line intraluminal plasty (TuLIP) in 11 patients over 16 months with fibrin sheath formation on pre-existing tunnelled haemodialysis catheters. Result All patients responded well to treatment with median line patency post TuLIP reaching 112 days. Conclusion TuLIP may have a role in extending catheter lifespan and delaying more invasive intervention.
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Tedla FM, Clerger G, Distant D, Salifu M. Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping. Clin J Am Soc Nephrol 2018; 13:1063-1068. [PMID: 29739749 PMCID: PMC6032590 DOI: 10.2215/cjn.14001217] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Central vein stenosis is considered to be common in patients on hemodialysis but its exact prevalence is not known. In this study, we report the prevalence of central vein stenosis in patients with CKD referred for vein mapping. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective study of adult patients who had bilateral upper extremity venographic vein mapping from September 1, 2011 to December 31, 2015. Patients with and without stenosis were compared for differences in clinical or demographic characteristics. Multiple logistic regression was used to identify independent associations between patient characteristics and central vein stenosis. RESULTS There were 525 patients who underwent venographic vein mapping during the study period, 27% of whom were referred before initiation of hemodialysis. The mean age (±SD) and body mass index were 59 (±15) years and 28 (±7), respectively. Women accounted for 45% of patients; 82% were black. The prevalence of central vein stenosis was 10% (95% confidence interval [95% CI], 8% to 13%) for the whole group, and 13% (95% CI, 10% to 17%) among patients with tunneled central venous dialysis catheters. Current use of tunneled hemodialysis catheters (odds ratio [OR], 14.5; 95% CI, 3.25 to 65.1), presence of cardiac rhythm devices (OR, 5.07; 95% CI, 1.82 to 14.11), previous history of fistula or graft (OR, 3.28; 95% CI, 1.58 to 6.7), and history of previous kidney transplant (OR, 18; 95% CI, 4.7 to 68.8) were independently associated with central vein stenosis. CONCLUSIONS In this population, the prevalence of central vein stenosis was 10% and was clustered among those with tunneled hemodialysis catheters, cardiac rhythm device, and previous history of dialysis access or transplant.
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Affiliation(s)
| | | | - Dale Distant
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
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Langston CE, Eatroff AE. Hemodialysis catheter-associated fibrin sheath in a dog. J Vet Emerg Crit Care (San Antonio) 2018; 28:366-371. [PMID: 29763987 DOI: 10.1111/vec.12721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/02/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe an intravascular fibrin sheath associated with a hemodialysis catheter in a dog. CASE SUMMARY A 4-year-old dog presented for hemodialysis to treat acute kidney injury. Hemodialysis catheter dysfunction during the course of treatment was temporarily alleviated using a tissue plasminogen activator. A thrombus composed of fibrin and granulation tissue creating a sheath around the catheter and focally adherent to the vessel wall was identified on postmortem evaluation. NEW OR UNIQUE INFORMATION PROVIDED Fibrin sheath formation is a commonly recognized problem of central venous catheters used for hemodialysis in people and is likely a common problem in veterinary patients undergoing dialysis as well. This report provides a description of the clinical features of the catheter dysfunction, response to treatment, postmortem radiographic and direct imaging, and histology of the fibrin sheath, and also provides a brief review of potential management techniques that have been described in people.
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Agarwal AK, Ash SR. Maintenance of blood flow rate on dialysis with self‐centering CentrosFLO catheter: A multicenter prospective study. Hemodial Int 2016; 20:501-509. [DOI: 10.1111/hdi.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/13/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Anil K. Agarwal
- Professor of Medicine, Chief, Section of Nephrology at University Hospiital East, Director, Interventional Nephrology, Director of Clinical Scholarship for FAME, The Ohio State University Wexner Medical CenterColumbus Ohio43210 USA
| | - Stephen R. Ash
- Nephrology DepartmentIndiana University Health Arnett, Ash Access Technology, Inc. and HemoCleanse Technologies, LLC3601 Sagamore Parkway North, Suite BLafayette Indiana47905 USA
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