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Arterial stiffness provides an indirect picture of vascular calcifications in terms of the effect they have on the systemic circulation and consequently on the heart. The present study sought to demonstrate the usefulness of outpatient investigation of vascular calcifications in dialysis patients using pulse wave velocity (PWV) determination. The aim of the study was to determine arterial resistance in patients with chronic dialysis kidney disease. The average study period was 48.5 ± 19.0 (SD) months. The study included 203 patients on dialysis with BCRT. The determination of arterial stiffness was measured at an interval of one hour after the dialysis session. The study highlighted the presence of an increased cardiovascular risk related to the presence of vascular calcifications without being able to establish a direct linear and causal link between their presence, location and the risk of cardiovascular events. The importance of highlighting calcifications and the consequences they generate means the possibility of influencing the main elements that can generate acute cardiovascular events. The results obtained and the correlations performed give an overview of the pathology studied, providing premises for therapeutic influence and risk assessment.

Valve calcifications are frequently associated with chronic terminal kidney disease (CTKD).There is a direct relationship between valvular calcifications and increased risk for cardiovascular events, respectively increased mortality in patients with CTKD. The aim of the study was to evaluate by Doppler echocardiography (ECoD) the prevalence of cardiac and valvular calcifications in patients with CTKD treated by hemodialysis (HD), and to correlate the data obtained with conventional and specific risk factors and the impact that valvular calcifications have on cardiovascular dysfunction with implications for morbidity and mortality. The study included 203 patients on dialysis with CTKD, aged between 20 and 84 years, who were monitored for a period of 48.5 ± 19.0 months in Arad County. On the studied group, the main etiologies for CTKD were chronic glomerulonephritis in 32% of patients, and diabetes in 22% of cases. A total of 322 calcifications were documented, of which valvular calcifications were estimated to have an incidence between 28% and 55% for the aortic valve and 56% for the mitral valve. Valvular calcification is associated with extensive atherosclerosis of the coronary arteries and aorta. Additional atherogenetic factors such as hypercholesterolemia, diabetes, hypertension and smoking were common. Some probable mechanisms such as increased mechanical stress due to hypertension, chronic volume overload, chronic inflammation, sympathetic hyperreactivity, lipid oxidation contribute to the appearance of vascular calcifications. Also, the number of cardiac calcifications correlates with the duration of the history of hypertension, regardless of whether or not the patient was still hypertensive at the time of the examination. Highlighting the valvular calcifications and intuiting the pathophysiological mechanisms that contribute to their appearance may be factors influencing the therapeutic behavior applied to dialysis patients. Given the large number of patients in whom calcifications were highlighted by echocardiography, it can be concluded that this method is particularly useful in detecting valvular calcifications in ambulatory dialysis patients.

The arterio-venous fistula is the elective vascular access for chronic hemodialysis patients. Its complications can severely affect the patient′s life, raise the morbidity and consequently the healthcare costs. Routinely, the arteriovenous fistula is evaluated clinically at the hemodialysis session, but numerous complications can only be diagnosed imastically, including those that endanger rhe well functioning of the access, and implicitely, of the dialysis. Doppler ultrasound is non-invasive, accurate, offers both morphological and functional details and allows the timely discovery of the anommalies of the arterio-venous fistula, moreover it is less costly and doesn′t require contrast media and ionizing radiations. The aim of the study is to establish the complications of the vascular access in 193 hemodialysis patients in Arad County, through Doppler ultrasound performed in the dialysis centre and to determine the clinical implications of these complications.

Vascular calcification and atherosclerosis are commonly associated with chronic terminal kidney disease (BCRT). The aim of the present study was to evaluate ultrasound the prevalence of calcifications and carotid plaques in BCRT patients treated with hemodialysis (HD), and to investigate the potential risk factors. The current observational-prospective study included 203 patients with BCRT, monitored for 48.5 ± 19.0 months and treated by hemodialysis in Arad county. The main etiologies for BCRT were chronic glomerulonephritis in 32% of cases and diabetes in 22% of cases. 43.84% of patients had a mean carotid IMT value ≥ 0.9. Carotid vascular calcification was found in 175 patients (86.20%), most calcifications being located at the level of the carotid bifurcation on the posterior wall. 105 carotid plaques have determined stenosis of the vessel's diameter. The total number of carotid plaques and plaques as well as the average value of carotid IMT were associated with age. Vascular calcifications were directly associated with the presence of diabetes. A linear association relation between vascular calcifications and carotid plaques was found, the correlation coefficient being equal to 0.73. Cardiovascular mortality was most strongly associated with the total number of carotid calcifications. Ultrasound remains the only readily available technique, capable of highlighting the non-calcified plaque. Highlighting the vascular calcifications and the intuition of the pathophysiological mechanisms that contribute to their appearance may be factors influencing the therapeutic behavior applied to dialysis patients.

The preservation of complication-free arterio-venous fistulas (AVF) for long-term hemodialysis (HD) use is associated with better overall patient outcomes, which is why this is a current goal in any HD center. Point-of-care ultrasound (POCUS) for in-center AVF assessment has proven its benefits in the identification of vascular access (VA) complications and as an additional tool to avoid blind cannulation. The current study aims to assess the change in the HD nurses’ perceptions regarding AVF POCUS use in the HD center. The nursing staff anonymously answered a Likert scale questionnaire with five questions related to various aspects of AVF POCUS utility shortly after the technique had been implemented and at a 5-year follow-up. The results showed an overall positive attitude toward this method, both at implementation and at follow-up, with no statistically significant score changes for four out of the five items assessed. However, we found a statistically significant reduction in the nurses’ cannulation confidence scores at the 5-year follow-up (p < 0.01). Overall, AVF POCUS implementation is regarded as a useful tool, with major benefits both for the patient and for the medical team. The current study results aim to support the introduction of AVF POCUS assessment as a standard practice from the nursing staff’s viewpoint. This study was not registered.

Purpose: To describe the histopathology of non-valved implant capsules in three cases of persistent postoperative hypotony after the restrictive tube ligature was released in patients receiving immunosuppressive therapy. Observations: The macroscopic appearance of the capsules 3 and 4 months postoperatively was immature and loose. Microscopic examination disclosed extremely irregular thin tissue, with thicknesses ranging from 0.02 to 0.6 mm, depending on the capsular location studied. Withdrawal of immunosuppressive therapy did not facilitate rebuilding of new capsules. Replacement with a valved implant device was necessary in two cases; the third case recovered with tapering of prednisone. Conclusions and Importance: The use of chronic systemic immunosuppressive therapy might interfere with capsular formation around the plates of drainage devices inducing persistent hypotony. In these cases, the use of valved implants might be safer.