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Articles by I. D Maya
Total Records ( 2 ) for I. D Maya
  D Sychev , I. D Maya and M. Allon

Background and objectives: Candidemia is a rare complication in catheter-dependent hemodialysis patients. As a result, there is uncertainty about its optimal medical management. The goal of this retrospective study was to compare the clinical outcomes of catheter-related candidemia managed with two different strategies: Guidewire exchange of the infected catheter versus removal with delayed replacement.

Design, setting, participants, & measurements: We retrospectively queried a prospective, computerized vascular access database to identify 40 hemodialysis patients with catheter-related candidemia. All patients underwent treatment with antifungal medications for 2 wk, in conjunction with guidewire catheter exchange or catheter removal with delayed replacement. The primary outcomes were major complications, recurrent candidemia, and patient survival.

Results: Candidemia represented approximately 2% of all cases of catheter-related bloodstream infections. Of the 40 patients with candidemia, 27 underwent guidewire catheter exchange and 13 had prompt catheter removal with delayed replacement. The two treatment groups were similar in demographic, clinical, and catheter characteristics. Only 1 (2.5%) patient developed a serious complication (endophthalmitis). Recurrence of candidemia within 3 mo was observed in 15% of each treatment group. Patient survival at 6 mo was similar in both groups.

Conclusions: Catheter-related candidemia is rare in hemodialysis patients and has a low complication rate. Catheter exchange over a guidewire in conjunction with antifungal therapy is an effective and safe treatment regimen.

  T. J Vachharajani , S Moossavi , L Salman , S Wu , I. D Maya , A. S Yevzlin , A Agarwal , K. D Abreo , J Work and A. Asif

The foundation of endovascular procedures by nephrologists was laid in the private practice arena. Because of political issues such as training, credentialing, space and equipment expenses, and co-management concerns surrounding the performance of dialysis-access procedures, the majority of these programs provided care in an outpatient vascular access center. On the basis of the improvement of patient care demonstrated by these centers, several nephrology programs at academic medical centers have also embraced this approach. In addition to providing interventional care on an outpatient basis, academic medical centers have taken a step further to expand collaboration with other specialties with similar expertise (such as with interventional radiologists and cardiologists) to enhance patient care and research. The enthusiastic initiative, cooperative, and mutually collaborative efforts used by academic medical centers have resulted in the successful establishment of interventional nephrology programs. This article describes various models of interventional nephrology programs at academic medical centers across the United States.

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