Kidney Dial., Volume 1, Issue 1 (September 2021) – 11 articles

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access. Full article

ANCA-associated vasculitis (AAV) poses a significant risk of kidney failure; kidney biopsy remains a key prognostic tool. The histopathologic classification of AAV glomerulonephritis (GN) developed by Berden et al. showed correlation between GN classes and kidney outcomes; ANCA Renal Risk Score (ARRS) included tubular atrophy and interstitial fibrosis (TA/IF) as an additional parameter for risk assessment. We aimed to evaluate kidney survival across AAV GN classes and ARRS groups. A single-center retrospective study included 85 adult patients with biopsy-proven AAV kidney disease followed in the period of 2000–2020. Primary outcome was kidney survival at the end of 18 (5; 66) months follow-up, and kidney death was considered as stage 5 CKD. We found significant differences in kidney survival for sclerotic, mixed, crescentic and focal AAV GN classes: 19%, 76.2%, 91.7% and 100%, respectively (p = 0.009). Kidney survival was 0%, 75.6% and 100% for the high-, medium- and low-risk ARRS groups, respectively (p < 0.001); TA/IF analysis showed kidney survival at 49.6% vs. 87.7% for widespread and mild TA/IF, respectively (p = 0.003). Kidney survival was significantly lower in anti-MPO-ANCA versus anti-PR3-ANCA carriers (50.3% and 78.1%, respectively, p = 0.045). We conclude that unfavorable AAV kidney outcomes are associated with sclerotic GN class by Berden’s classification, ARRS high risk group, and anti-MPO-ANCA subtype. Full article

Since joining the Non-Governmental Organization Ubiquitous Blood Purification International in 2014, professionals who are mainly members of the Japanese Society for Dialysis Therapy (JSDT) have worked toward promoting dialysis therapy in several countries through help with organization of local nephrology societies and conducting educational activities. Since 2016, training at our hospital has been provided for doctors and dialysis staff from these countries as part of the activities of the JSDT. These activities also involve technical training for vascular access (VA) surgery and management. To date, lectures and practical teaching on VA procedures have been given in Cambodia and Vietnam, and a hands-on seminar on echo-guided puncture and VA management was held in Mongolia. In Mongolia and Myanmar, a plan to provide systemic VA surgery education has been developed, at the request of local nephrology societies. Doctors and medical staff from Vietnam, Laos, Cambodia, Nepal and Indonesia have visited our hospital and have observed operations as part of their training. To achieve sustainable medical support and academic activities, we have found it to be important to have a counterpart society in each country, and guidance has been provided when required on organization of a national nephrology society. Full article

Abnormalities in mineral metabolism, soft tissue calcifications, and bone health are common in people with chronic kidney disease (CKD). In this scenario, osteoporosis is a highly prevalent skeletal disorder characterized by reduced bone strength predisposing patients to adverse health outcomes. We will summarize the evidence of the prevalence of osteoporosis in adults with CKD. Methods: We will perform a comprehensive literature search using MEDLINE, EMBASE, Web of Science, CINAHL, and LILACS databases, without date or language restrictions from inception until January 2021. We will include cross-sectional, case–control, or cohort studies that report prevalence data of osteoporosis in adults aged ≥18 years with CKD in stages 3a–5, including those receiving kidney replacement therapies. We will exclude conference abstracts and experimental studies. The primary outcome will be the prevalence of osteoporosis according to the World Health Organization criteria (T-score ≤ −2.5). Two independent reviewers will screen title and abstract, full-text review, critical appraisal of the quality of studies, risk of bias, heterogeneity, and data extraction. The quality of the included studies will be assessed with the Joanna Briggs Institute (JBI) appraisal checklist. The overall prevalence of the studies will be synthesized using random-effects meta-analysis. This systematic review will be reported according to the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE) and the JBI methodological guidance for systematic reviews of observational epidemiological studies. The qualitative and quantitative results will be synthesized and presented in tables, figures or graphs. Full article

High flow access (HFA) is a condition in which hemodynamics is affected by a flow rate that is larger than the blood flow required for hemodialysis. HFA sometimes causes high output heart failure, venous hypertension, and dialysis access steal syndrome. Flow reduction is effective for improving symptoms, and various surgical procedures have been reported. HFA is recognized as a well-developed type of access due to its good access sound, thrill, and vessel diameter; also, HFA probably has good patency if not intervened with by flow reduction. Therefore, the blood flow reduction procedures used to treat HFA need to minimize disadvantages such as access thrombosis, insufficient blood flow, aneurysm formation, and infection due to therapeutic intervention while, at the same time, achieving symptom improvement and long-term patency. The surgical procedure used to correct HFA must be highly reproducible and simple. This article reviews the pathophysiology and surgical flow reduction procedures for HFA. Full article

The prevention of peritoneal dialysis (PD) catheter complications is essential to achieve a successful outcome. In recent years, nephrologists have performed more PD catheter insertion surgeries in Japan. The prevention of catheter complications is crucial for nephrologists who do not have all-around surgical skills. PD catheter tip migration is a common complication and a significant cause of catheter malfunction. Several preventive techniques have been reported for the PD catheter tip migration. This perspective described the following: (1) surgical technique in laparotomy, (2) laparoscopic surgery, (3) peritoneal wall anchor technique, and (4) catheter type selection. We hope that more effective methods of preventing catheter complications will be developed to ensure the success of PD treatment. Full article

Hemodialysis access stenosis is a pervasive problem that occurs due to the physiology of the high-flow circuit. Stenosis occurs due to endothelial and smooth muscle injuries that result in neointimal hyperplasia. Percutaneous transluminal angioplasty is the standard treatment for dialysis access-induced stenosis. Unfortunately, it is also associated with vessel wall trauma, which causes further intimal hyperplasia and restenosis. Data from randomized controlled trials (RCTs) and systematic reviews of the use of drug-coated balloons (DCBs) for dialysis access stenosis have been controversial. While several single-center trials or RCTs have reported safe and effective use of DCBs, conflicting results still exist. Furthermore, paclitaxel is known to be associated with an increased mortality risk. Herein, we review the current evidence on the role of DCBs in the treatment of dialysis access stenosis. Full article

The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure wound therapy (NPWT) is a non-invasive procedure that promotes wound healing by sealing the wound under negative pressure. Although NPWT is practically accepted in general surgery, there are only a few reports of this strategy to the vascular access operation for patients with hemodialysis due to the possibility of severe bleeding. In the present report, we report a case of a patient who successfully achieved safe and early wound closure by NPWT against compromised wound healing after AVG infection. Full article

Blood access is a lifeline for dialysis patients. However, serious problems such as stenosis or obstruction of access blood vessels, which are life-threatening conditions in daily clinical practice, still remain. One of the most promising candidates for solving these problems may be Biotube blood vessels. More than 20 years have passed since the development of in-body tissue architecture (iBTA), a technology for preparing tissues for autologous implantation in patients. The tissues obtained by iBTA do not elicit immunological rejection, which is one of the ultimate goals of regenerative medical engineering; however, their practical applications were quite challenging. The seemingly unorthodox iBTA concepts that do not follow the current pre-established medical system may not be readily accepted in general medicine. In contrast, there are many diseases that cannot be adequately addressed even with the latest and most advanced medical technology. However, iBTA may be able to save patients with serious diseases. It is natural that the development of high-risk medical devices that do not fit the corporate logic would be avoided. In order to actively treat such largely unattached diseases, we started Biotube Co., Ltd. with an aim to contribute to society. Biotubes induced by iBTA are collagenous tubular tissues prepared in the patient’s body for autologous implantation. The application of Biotubes as tissues for vascular implantation has been studied for many years. Biotubes may have excellent potential as small-diameter artificial blood vessels, one of the most difficult to clinically achieve. Their possibility is currently being confirmed in preclinical tests. Biotubes may save hundreds of thousands of patients worldwide annually from amputation. In addition, we aim to eliminate the recuring access vascular problems in millions of dialysis patients. This study provides an update on the current development status and future possibilities of Biotubes and their preparation molds, Biotube Makers. Full article

As passionate readers, occasional writers, reviewers, and editors with different experiences, when we were asked to participate in shaping and proposing a new journal, the first question that we had to deal with was, of course, “do we really need a new nephrology journal [...] Full article