November 16, 2001 - The American Hospital Association web site is reporting that the Centers for Disease Control and Prevention (CDC) is seeking comments on a <font color="#0000FF">proposed renewal of a study</font> on bloodstream infections, vascular access infections, hospitalization, and antimicrobial starts at U.S. outpatient hemodialysis centers.<br /><br />This is a portion of the information regarding this study that appeared in the <font color="#0000FF">Federal Register</font> for November 15th:<blockquote>Proposed Project<br /><br />Surveillance for Bloodstream and Vascular Access Infections in Outpatient Hemodialysis Centers (0920-0442)--Renewal--National Center for Infectious Diseases (NCID), NCID Centers for Disease Control and Prevention (CDC), is proposing to renew a study of bloodstream infections, vascular access infections, hospitalization, and antimicrobial starts at U.S. outpatient hemodialysis centers. Although bloodstream and vascular access infections are common in hemodialysis patients, there was previously no system to record and track these complications.<br /><br />Participation in the proposed project is voluntary. Currently about 80-90 centers report data each month. We estimate that about 100 of the approximately 4,500 U.S. outpatient hemodialysis centers will participate in the coming years. Participating centers may collect data continuously, or may discontinue participation at any time; we estimate that the average center will participate for nine months. Each month, participating centers will record the number of hemodialysis patients they treat and maintain a log of all hospitalizations and intravenous (IV) antimicrobial starts. For each hospitalization or IV antimicrobial start, further information (e.g., type of vascular access, clinical symptoms, presence of a vascular access infection, and blood culture results) will be collected. These data may be reported to CDC on paper forms or via a secure Internet site. CDC aggregates this data and generates reports which are sent to participating dialysis centers.<br /><br />Centers that participate in the Internet-based reporting system may also analyze their own data and print out reports as desired. Rates of bloodstream infection, vascular access infection, and antimicrobial use per 1000 patient-days will be calculated. Also, the percentage of antimicrobial starts for which a blood culture is performed will be calculated. Through use of these data, dialysis centers will be able to track rates of key infectious complications of hemodialysis. This will facilitate quality control improvements to reduce the incidence of infections, and clinical practice guidelines to improve use of antimicrobials. The total cost to the respondents is $126,000.</blockquote><br />October 30, 2001 - Here are the latest scientific studies on vascular access for hemodialysis:<blockquote>"Analysis of Variable Flow Doppler Hemodialysis Access Flow Measurements and Comparison With Ultrasound Dilution" - <font color="#0000FF">abstract from AJKD</font> (American Journal of Kidney Diseases).<blockquote>"VF Doppler therefore yields reproducible access volume flow measurements that correlate with ultrasound dilution measurements. The VF Doppler method is dependent on the pump-induced change in access Doppler signal and therefore is inherently most accurate and reproducible at lower access blood flow rates. This method appears capable of determining access flow rates in the clinically useful range."</blockquote>"Optimizing Dialysis Dose by Increasing Blood Flow Rate in Patients With Reduced Vascular-Access Flow Rate" - <font color="#0000FF">abstract from AJKD</font>.<blockquote>"From this study, it is concluded that even in patients with low access flow, increasing dialyzer blood flow rate in general leads to an increase in delivered Kt/V regardless of vascular access flow rate."</blockquote>"Clinical Consequences of Infected Arteriovenous Grafts in Hemodialysis Patients" - <font color="#0000FF">abstract from AJKD</font>.<blockquote>"In conclusion, graft infection results in substantial morbidity, prolonged dependence on dialysis catheters, and multiple vascular-access procedures."</blockquote>Case Report: "Diagnosis of Unexplained Bleeding from Tunneled Dialysis Catheter" - <font color="#0000FF">abstract from American Journal of Nephrology</font>.<blockquote>Prolonged bleeding was "due to unsuspected catheter leak within the tunneled portion of the catheter, which was identified with angiogram."</blockquote>"A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters" - <font color="#0000FF">abstract from NDT</font> (Nephrology Dialysis Transplantation). <blockquote>"Less than half of the hemodialysis catheters were removed electively because of availability of a more permanent mode of renal replacement, thereby illustrating the level of dependence that has developed on them as permanent access. Consequently, their limitations (infection and malfunction) are placing an ever increasing burden on the healthcare services."</blockquote>"Role of type of vascular access in erythropoietin and intravenous iron requirements in haemodialysis" - <font color="#0000FF">abstract from NDT</font>.<blockquote>"The use of a PTFE graft and anti-platelet drugs represents a previously undescribed association related to higher Epo and i.v. iron requirements. The association described herein adds new arguments to the debate concerning the choice of vascular access in chronic haemodialysis patients."</blockquote></blockquote><br />September 28, 2001 - Here are the latest scientific studies on vascular access for hemodialysis:<blockquote>"Long-Term Outcome of Permanent Hemodialysis Catheters: A Controlled Study" - <font color="#0000FF">study from Blood Purification</font><br /><br />"Type of vascular access and mortality in U.S. hemodialysis patients" - <font color="#0000FF">abstract from Kidney Int'l</font><br /><br />"Hemodialysis vascular assessment by an ultrasound dilution method (transonic) in patients older than 65 years" - <font color="#0000FF">study in International Urology and Nephrology</font><br /><br />"Treatment and prevention of catheter-related infections in haemodialysis patients" - full editorial in Nephrology Dialysis Transplantation (link is no longer available.<br /><br />"Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis " - <font color="#0000FF">technical note from NDT</font><br /><br />"A protocol of urokinase infusion and warfarin for the management of the thrombosed haemodialysis catheter" - <font color="#0000FF">technical note from NDT</font><br /><br />"Buzz in the Axilla: A New Physical Sign in Hemodialysis Forearm Graft Evaluation" - <font color="#0000FF">article from AJKD</font> (American Journal of Kidney Diseases)</blockquote><br /><br />September 9, 2001 - The Centers for Disease Control and Prevention (CDC) has released a draft entitled,<blockquote>"Guideline for Prevention of Intravascular Catheter-Related Infections". Here is the notice that appeared in the Federal Register today. (link is no longer available)<br /><br />Here are the <font color="#0000FF">draft guidelines in pdf format</font>. The CDC has <font color="#0000FF">set up a page</font> for requesting copies of the guidelines by mail and for submitting comments. Comments are due by October 22.</blockquote>In other access related news, the FDA recently approved a <font color="#0000FF">new thrombolytic for CVADs</font>. <br /><br />Also, here is <font color="#0000FF">a press release</font> from EurekAlert and the University of North Carolina at Chapel Hill: "Study: nitric oxide-releasing materials might reduce medical implant infections".<br /><br />September 1, 2001 - Here are recent studies and articles about hemodialysis accesses:<blockquote>"Timing of Nephrologist Referral and Arteriovenous Access Use: The CHOICE Study" - <font color="#0000FF">abstract from AJKD</font> (American Journal of Kidney Diseases)<br /><br />�High Incidence of Severe Twin Hemodialysis Catheter Infections in Elderly Women� - <font color="#0000FF">abstract from Nephron</font><br /><br />"Successful Use of Tesio Catheters in Pediatric Patients Receiving Chronic Hemodialysis" - <font color="#0000FF">abstract from AJKD</font><br /><br />"Hemodialysis Access Placement With Preoperative Noninvasive Vascular Mapping: Comparison Between Patients With and Without Diabetes" - <font color="#0000FF">abstract from AJKD</font><br /><br />"Vascular access blood flow monitoring reduces access morbidity and costs" - <font color="#0000FF">abstract from Kidney International</font><br /><br />"Long-term experience with the Thomas shunt, the forgotten permanent vascular access for haemodialysis" - <font color="#0000FF">abstract from NDT</font> (Nephrology Dialysis Transplantation)</blockquote><br />July 10, 2001 - The use of cryopreserved femoral veins for patients with persistent hemodialysis access problems seems to offer clear benefits. These grafts reduce infection rates at the access sites and a femoral vein remains open and viable for prolonged periods. <font color="#0000FF">Cryolife, Inc.</font> is one of the companies that provides cryopreserved femoral veins for hemodialysis access.<br /><br />However, the July issue of the Journal of Vascular Surgery has a study which states that dimethyl sulfoxide�cryopreserved cadaveric vein allografts should not be used for hemodialysis access in potential kidney transplant recipients because it leads to broad allosensitization as measured by PRA assay.<blockquote>Here is <font color="#0000FF">the abstract</font> of the study entitled, "Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization".</blockquote><br />August 1, 2001 - Here are three new abstracts about vascular accesses:<blockquote>"Clinical performance characteristics of hemodialysis graft monitoring" - <font color="#0000FF">abstract from Kidney International</font><br /><br />"Screening for Subclinical Stenosis in Native Vessel Arteriovenous Fistulae" - <font color="#0000FF">abstract from the Journal of the American Society of Nephrology</font><br /><br />"Evidence of Calcium Phosphate Depositions in Stenotic Arteriovenous Fistulas" - <font color="#0000FF">abstract from the American Journal of Kidney Diseases</font></blockquote><br /><br />July 7, 2001 - The latest issue of Seminars in Dialysis has two articles that debate the topic of Access Blood Flow Monitoring:<blockquote>"Blood Flow Surveillance of Hemodialysis Grafts and the Dysfunction Hypothesis" - <font color="#0000FF">abstract from Seminars in Dialysis</font><br /><br />"Access Flow Measurement as a Predictor of Hemodialysis Graft Thrombosis: Making Clinical Decisions" - <font color="#0000FF">abstract from Seminars in Dialysis</font></blockquote><br />July 5, 2001</B> - Here are two articles from Kidney International and a new information booklet from the NIDDK on hemodialysis vascular access:<blockquote>"Infectious complications of the hemodialysis access" - <font color="#0000FF">abstract from Kidney International</font><br /><br />"Noninvasive transcutaneous determination of access blood flow rate" - <font color="#0000FF">abstract from Kidney International</font><br /><br />"Vascular Access for Hemodialysis" - <font color="#0000FF">booklet from NIDDK</font> (National Institute of Digestive & Diabetes & Kidney Disease). This is for patients that have just been diagnosed with kidney disease.</blockquote><br /><br />[b]June 1, 2001 - "Access Blood Flow as a Predictor of Early Failures of Native Arteriovenous Fistulas in Hemodialysis Patients" - <font color="#0000FF">abstract from the American Journal of Nephrology</font><br /><br />June 1, 2001 - Vasca, Inc. announced today that it has raised $19.6 million of private equity capital (link is no longer available). MVM Ltd, a UK based medical venture fund, led this round of financing. Stephen Reeders M.D., Chief Executive Officer of MVM and a nephrologist, will join Vasca's Board of Directors. <br /><br />In August 2000, Vasca received 510(k) clearance for its LifeSite� Hemodialysis Access System. Here is the <font color="#0000FF">press release</font> from the Vasca web site.<br /><br />In June 2000, Vasca announced it would receive $4 million of a $10 million Series E Preferred investment round from Pacific Venture Group (PVG), a leading healthcare focused venture capital firm. In July 1999, Vasca announced that it had completed a $12 million round of private financing. <br /><br />May 31, 2001 - There are several new articles about hemodialysis access:<blockquote><font color="#0000FF">Here is the abstract</font> of a just-published study from the CDC and John Hopkins entitled, "A Prospective Study of Vascular Access Infections at Seven Outpatient Hemodialysis Centers" - from the June issue of the American Journal of Kidney Diseases (AJKD). The study finds that access infection rates differ substantially among different dialysis centers and that catheter use should be minimized.<br /><br />This paper suggests that retrograde access flow develops before access recirculation, indicating that this finding is more sensitive than recirculation for detecting access dysfunction. <font color="#0000FF">Here is the abstract</font> of the articled entitled, "Retrograde Hemodialysis Access Flow During Dialysis as a Predictor of Access Pathology" - from the June issue of AJKD.<br /><br />"Dialysis access induced limb ischemia corrected using quantitative duplex ultrasound" - <font color="#0000FF">abstract from Pediatric Nephrology</font><br /><br />May 1, 2001 - There are several new articles this month about hemodialysis access:<blockquote>"Thrombotic Complications of Chronic Hemodialysis Vascular Access: Fistulas and Grafts" - <font color="#0000FF">from UpToDate�</font><br /><br />"Predictors of Arteriovenous Graft Patency After Radiologic Intervention in Hemodialysis Patients" - <font color="#0000FF">abstract from the American Journal of Kidney Disease</font><br /><br />�Flow In Hemodialysis Grafts After Angioplasty: Do Radiologic Criteria Predict Success?" - <font color="#0000FF">abstract from Kidney International</font><br /><br />�Oxidative Stress and Increased Expression of Growth Factors in Lesions of Failed Hemodialysis Access" - <font color="#0000FF">abstract from the American Journal of Kidney Disease</font><br /><br />"Arteriovenous Fistula Construction in the Thigh with Transposed Superficial Femoral Vein: Our Initial Experience" - <font color="#0000FF">abstract from the Journal of Vascular Surgery</font></blockquote><br /><br />May 1, 2001 - �Biofilms and Device-Associated Infections� - <font color="#0000FF">article from the Centers for Disease Control</font><br /><br /><br />[This message has been edited by Gary Peterson (edited 01-29-2002).]

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