31st Annual Conference on Peritoneal Dialysis, 17th International Symposium on Hemodialysis, and 22nd Annual Symposium on Pediatric Dialysis
we performed 245 native AVF at the wrist or distal forearm in patients with end-stage renal failure (ESRF) before starting dialysis. Forty-six patients were insulin dependent and 199 were not diabetic but they had come to ESRF for other nephropathies. The mean age in the diabetic group was 62.4 AE 15.6 years and 14 of the 46 were female, whereas in the nondiabetic group, the mean age was 63.8 AE 17.3 years and 61 of 199 were female. The end-to-side anastomosis was used in 52.2% of diabetic and
... n 50.3% of no diabetic patients without any significant difference. In other patients we performed a end-to-end anastomosis. The preoperative evaluation was done by the same nephrologists who took care to create an AVF in the operating room located inside the dialysis center. Patients with suitable vessel (diameter not less than 2-2.5 mm for the artery and vein, respectively) were chosen. The average time to first dialysis treatment after operation was 2.38 AE 1.83 months in diabetic and 2.19 AE 1.79 months in nondiabetic group. The statistical study was performed by comparing averages and between the Student t-test and the chi-square test. Results: The median survival of distal AVF was 21.59 AE 20.85 months in diabetic patients and 27.48 AE 22.51 months in patients without diabetes. This difference was significant to the Student t-test (P= 0.05). Examining the AVF survival curves in both groups of patients, we found that the primary patency 1 year rate was 56.1% in diabetic patients and 73.1% in nondiabetics with P= 0.025 to the chi-square test. Over time, the survival of AVF in patients without diabetes was not statistically significant. Conclusions: The study we have conducted on distal native AVF in patients who have to start dialysis treatment, leads us to conclude that diabetic patients could not be considered for a distal native AVF because a primary patency 1 year rate significantly reduced compared with nondiabetic patients. But, the policy of vascular savings and the chance of reusing arterialized veins after failing of the primary AVF, may suggest preparing a distal AVF also in diabetic patients. In any case, it is in the experience and wisdom of those who deal with these issues, to decide whether to prepare, for starting dialysis, a distal AVF in patients with compromised vessels such as those found in diabetics. Purpose: To develop an organizational model for making and revising the permanent vascular access (VA) in dialysis or starting 31st Annual Dialysis Conference: Abstracts Purpose: The number of tunneled cuffed catheter (TCC) in hemodialysis (HD) patients is increasing, however, there are few data about natural history of TCC removed in asymptomatic HD patients. The purpose of this study is to evaluate pull-back venographic and gross findings of removed TCCs. Methods: One hundred two TCCs were removed between March 2009 and June 2010. Pull-back venography was performed and we recognized the presence of fibrin sheath around the catheter, filling defects suspicious of thrombus and stenotic lesions. Removed TCCs were cut at 1 and 2 cm from the tip and intracatheter fibrin and thrombi were grossly investigated. Results: Mean age of the patients was 57.8 AE 13.5 years and 60 patients (58.8%) were men. Patients with diabetes mellitus accounted 65.7% (n= 67). A total of 45 (44.1%) of 102 cases had abnormal venographic findings such as fibrin sheath (35.3%), thrombus (7.8%), and stenosis (2.9%). Intracatheter fibrin and thrombus was detected in 53 (51.9%) catheters by gross evaluation of cut lumen. Overall, 74 (72.5%) out of 102 patients had catheter related complications on the inside or outside of the catheter. Conclusion: This study shows that a considerable number of asymptomatic HD patients have catheter-related problems. The reduction of the number of dwelling TCCs is thought to be more important than the adequate management to prevent complications. States. Models were adjusted for case-mix. Results: Patients were 61 AE 15 years old and included 47% women, 46% diabetics, and 34% African Americans. The 13-week averaged platelet count was 229 AE 78 Â 10 3 /mL. In unadjusted, and case-mix adjusted models, incrementally higher Kt/V values up to 2.2 were associated with lower platelet count whereas Kt/V below 1.2 or above 2.2 exhibit highest thrombocytosis (see figure) . Conclusions: Lower hemodialysis dose in MHD patients is associated with relative thrombocytosis, which may explain the poor outcomes observed with inadequate dialysis treatment. Additional studies need to verify these findings.