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• W1514216084 abstract "Renal replacement therapy (RRT), including various delivery types of haemodialysis, has revolutionised the care of patients with end stage renal disease (ESRD). The most common RRT modality is haemodialysis (ANZ Data 2010, Boddana et al., 2009). Access for dialysis is via arteriovenous fistulae (AVF), arteriovenous grafts (AVG) or via central venous dialysis catheters. The goal of access is to provide a means of accessing the vasculature to undertake RRT in order to deliver the optimal dialysis dose with the minimal associated morbidity and mortality. The National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (KDOQI, 2006) guidelines recommend an AVF prevalence rate of greater than 65%. Arteriovenous fistulae remain the preferred method of access due to improved survival rate and lower associated morbidity and associated medical costs (NKF-KDOQI, 2006). Despite all these measures, dialysis catheters remain commonly used for a variety of reasons. They are now well acknowledged as the harbinger of potential future significant morbidity and mortality. As a result of the significant morbidity burden caused by dialysis catheters, there has been great interest in discovering new and inventive methods of reducing catheter-related infection. Out of this is borne the investigation of preventative measures outlined here. This is particularly important given the immunosuppressed nature of renal patients. The evidence for, and utility of measures, such as topical antimicrobial ointment application, antimicrobial catheter lock solutions, antibiotic impregnated catheters, differing AVF cannulation methods and catheter design, shall be explored below. As we strive for improved outcomes in our patients many more patients are undertaking extended hours home haemodialysis. In those patients with the lowest risk accesses, questions have been raised as to the method of access cannulation and the spectre of increasing associated infectious events. The rope ladder technique involves regular rotation of cannulation sites whereas buttonhole technique uses the same cannulation sites and relies on formation of a track which is then repetitively accessed with blunt needles. This has been a very attractive method for home dialysis patients for a range of reasons. However, despite recent popularity with this technique, a number of studies including from our centre, have now shown that this technique is associated with increased septic events (Birchenough et al., 2008; Nesrallah et al., 2010; Van Eps et al., 2010; Van Loon et al., 2010)." @default.
• W1514216084 created "2016-06-24" @default.
• W1514216084 creator A5015788445 @default.
• W1514216084 creator A5055348554 @default.
• W1514216084 creator A5059318645 @default.
• W1514216084 date "2011-12-07" @default.
• W1514216084 modified "2023-09-26" @default.
• W1514216084 title "Hemodialysis Access Infections, Epidemiology, Pathogenesis and Prevention" @default.
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