Search this website

Saravanan Balamuthusamy, MD

Subscribe to Saravanan Balamuthusamy, MD feed Saravanan Balamuthusamy, MD
NCBI: db=pubmed; Term=Balamuthusamy S[Author]
Updated: 13 hours 49 min ago

Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas.

Wed, 01/30/2019 - 08:36
Related Articles

Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas.

J Vasc Access. 2017 Jul 14;18(4):319-324

Authors: Balamuthusamy S, Reddi AL, Madhrira MH, Sankarapandian B, Nguyen P, Vallurupalli A, Gabbard W, Jalandhara N, Yurvati A

Abstract
INTRODUCTION: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis.
METHODS: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software.
RESULTS: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis.
CONCLUSIONS: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.

PMID: 28665461 [PubMed - indexed for MEDLINE]

Self-centering split-tip catheter versus conventional split-tip catheter in prevalent hemodialysis patients.

Wed, 01/30/2019 - 08:36
Related Articles

Self-centering split-tip catheter versus conventional split-tip catheter in prevalent hemodialysis patients.

J Vasc Access. 2016 May 07;17(3):233-8

Authors: Balamuthusamy S, Nguyen P, Bireddy S, Vallurapalli A, Jalandhara N, Afolabi D

Abstract
PURPOSE: This study compared the patency of a split-tip self-centering catheter with a predesigned curve (CentrosFLO; Merit, Salt Lake City, Utah) and a standard split-tip catheter with straight distal limbs (Medcomp, Harleysville, Pennsylvania) catheter in patients requiring exchange of a dysfunctional tunneled dialysis catheter (TDC).
MATERIALS AND METHODS: A single-center retrospective chart review was performed between January 2013 and July 2014. Patients had an existing dysfunctional TDC that was exchanged over a wire using the same access site for either a split-tip self-centering catheter with a predesigned curve or a standard split-tip catheter with straight distal limbs catheter. The primary endpoint was catheter patency analyzed at 1, 3, and 6 months after initial exchange.
RESULTS: A total of 73 patients met inclusion criteria (46 in the self-centering catheter group and 27 in the standard split-tipped group). Mean durations of the exchanged catheters were similar between groups. The mean 1-, 3-, and 6-month patency rates for the self-centering and split-tip catheters were 89%, 67.4%, and 23.9% and 81.5%, 40.7%, and 14.8%, respectively. Mean blood flow rates (BFRs) were similar between groups at 1 and 3 months; however, at 6 months, mean rates were 388 mL/min versus 352 mL/min for the self-centering group and split-tipped group, respectively (p<0.01).
CONCLUSIONS: These results demonstrate improved patency with the CentrosFLO self-centering catheter versus the split-tip catheter. This may be due to the unique design of the self-centering catheter, allowing for preserved BFRs and patency. These results should be further explored in prospective, randomized multicenter studies.

PMID: 26980629 [PubMed - indexed for MEDLINE]

Flow reduction in high-flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization.

Wed, 01/30/2019 - 08:36
Related Articles

Flow reduction in high-flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization.

Hemodial Int. 2016 07;20(3):362-8

Authors: Balamuthusamy S, Jalandhara N, Subramanian A, Mohanaselvan A

Abstract
High output heart failure (HF) and pulmonary hypertension have been demonstrated in patients with prevalent arteriovenous (AV) fistulas. Fistulas with flow >2000 mL/minutes are more likely to induce changes in cardiac geometry and pulmonary artery pressure. The effects of reducing flow in AV access and its implications on HF decompensation and hospitalizations have not been studied. Retrospective analysis of 12 patients who needed hospitalization for acute Congestive Heart Failure (CHF) decompensation with AV access flow of 2 L/minutes (as defined by Kidney Disease Outcomes Quality Initiative (KDOQI)) or more were included in the study. All the patients underwent banding of their inflow at the anastomosis with perioperative access flow measurement. Follow-up period was 6 months. 2D echo was done at 6 months postbanding in addition to access flow and clinical evaluation. Complete data was available for all the 12 patients. Study data was collected on all the 12 patients. Mean age was 64.7 years. The mean access flow pre and postbanding were 3784 mL/minutes and 1178 mL/minutes, respectively (P < 0.001). Eighty percent of the patients had diabetes and 41% had coronary artery disease. There was a statistically significant decrease in cardiac output (pre = 7.06 L/minutes, post = 6.47 L/minutes P = 0.03), pulmonary systolic pressure (pre = 54 mmHg, post = 44 mmHg P = 0.02), left ventricular mass index (LVMI) (pre = 130 g/m(2) , post = 125 g/m(2) P = 0.006) and need for rehospitalization for CHF decompensation. The New York Heart Association (NYHA) staging improved by 1 stage postbanding (P = 0.002). The hospitalization rate was 3.75 ± 1.2 in the 6 months before banding and was decreased to 1.08 ± 1.2 (P = 0.002) postbanding. The hemoglobin level, predialysis systolic blood pressure, calcium phosphorous product and the use of Renin Angiotensin Aldosterone System (RAAS) blockade agents and calcium channel blockers were comparable before and after inflow banding. Flow reduction in high flow fistulas are associated with decreased LVMI and pulmonary artery pressures. There is also a significant reduction in the risk for hospitalization due to acute HF and an improvement in NYHA heart failure stage.

PMID: 26663664 [PubMed - indexed for MEDLINE]

Percutaneous Peritoneal Dialysis Catheter Placement in Patients with Complex Abdomen.

Wed, 01/30/2019 - 08:36
Related Articles

Percutaneous Peritoneal Dialysis Catheter Placement in Patients with Complex Abdomen.

Semin Dial. 2015 Nov-Dec;28(6):680-6

Authors: Jalandhara N, Balamuthusamy S, Shah B, Souraty P

Abstract
Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. There are several techniques of percutaneous PD catheter placement including trocar or Seldinger techniques. Placement can be performed with fluoroscopy and/or sonography or as a blind percutaneous procedure. Historically, percutaneous PD catheters have been placed in patients even if they had prior abdominal surgeries. The outcomes of percutaneous PD catheter placement in patients with complex abdomen (patients with two or more abdominal surgeries or known adhesions) are unknown. This study was carried out to determine the outcomes of percutaneous PD catheter placements using Seldinger technique with sonography and fluoroscopy in patients with complex abdomen. Preprocedure sonography was also used to identify site of adhesions and blood vessels. The goal was to see if ultrasound and fluoroscopy would support placement of PD catheters in patients with complex abdomens. There were total of 10 catheter placements in 10 patients with complex abdomen. The initial success rate was 100%. The patients had an average of 2.8 abdominal surgeries. The mean BMI was 28.4. There were no incidences of perforation or failed placements. One catheter was replaced due to outflow failure and one patient discontinued PD due to peri-catheter leak. One year catheter survival was 80%. Our study demonstrates benefits of using ultrasonography and fluoroscopy during percutaneous PD catheter placement by the Seldinger technique in patients with complex abdomen.

PMID: 26138688 [PubMed - indexed for MEDLINE]

Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

Wed, 01/30/2019 - 08:36
Related Articles

Persistent Median Artery As A Cause Of Nonmaturing AV Fistula.

Semin Dial. 2015 Sep-Oct;28(5):552-7

Authors: Jalandhara N, Balamuthusamy S, Skaria S, Jalandhara P, Hansen J, Waiganjo N

Abstract
A 68-year-old right handed male with End-Stage Renal Disease with a left radiocephalic fistula created 8 months ago was referred for the evaluation of a nonmaturing access. Patient had an arterial anastomosis lesion that underwent successful angioplasty. Diagnostic arteriogram of the AV access extremity revealed the presence of a short radial artery and dominant common interosseous artery manifesting as a persistent median artery in the distal forearm and was anastomosed to the fistula and then continues as the median-ulnar superficial arch in the palm. Balloon angioplasty of the common interosseous artery led to a complication when the distal 30 cm of the 0.018 guide wire fractured and had to be retrieved using a snare device. In addition to anticipating and treating the common complications of vascular access procedures, it is also important to be aware of the anomalies of the distal forearm arterial anatomy and perform a detailed arterial evaluation prior to creating the arterio-venous anastomosis.

PMID: 25787139 [PubMed - indexed for MEDLINE]

Renal sympathetic nervous system and the effects of denervation on renal arteries.

Wed, 01/30/2019 - 08:36
Related Articles

Renal sympathetic nervous system and the effects of denervation on renal arteries.

World J Cardiol. 2014 Aug 26;6(8):814-23

Authors: Kannan A, Medina RI, Nagajothi N, Balamuthusamy S

Abstract
Resistant hypertension is associated with chronic activation of the sympathetic nervous system resulting in various comorbidities. The prevalence of resistant hypertension is often under estimated due to various reasons. Activation of sympathetic nervous system at the renal- as well as systemic- level contributes to the increased level of catecholamines and resulting increase in the blood pressure. This increased activity was demonstrated by increased muscle sympathetic nerve activity and renal and total body noradrenaline spillover. Apart from the hypertension, it is hypothesized to be associated with insulin resistance, congestive heart failure and obstructive sleep apnea. Renal denervation is a novel procedure where the sympathetic afferent and efferent activity is reduced by various techniques and has been used successfully to treat drug-resistant hypertension improvement of various metabolic derangements. Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Renal denervation can be done by various techniques including radiofrequency ablation, ultrasound guided ablation and chemical ablation. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Appropriate patient selection might be the key in determining the effectiveness of the procedure.

PMID: 25228960 [PubMed]

Effect of spironolactone in CV mortality in hemodialysis patients.

Wed, 01/30/2019 - 08:36
Related Articles

Effect of spironolactone in CV mortality in hemodialysis patients.

J Am Coll Cardiol. 2014 Aug 05;64(5):528-9

Authors: Kannan A, Poongkunran C, Balamuthusamy S

PMID: 25082591 [PubMed - indexed for MEDLINE]

Coronary Revascularization in Chronic and End-Stage Renal Disease: A Systematic Review and Meta-analysis.

Wed, 01/30/2019 - 08:36
Related Articles

Coronary Revascularization in Chronic and End-Stage Renal Disease: A Systematic Review and Meta-analysis.

Am J Ther. 2016 Jan-Feb;23(1):e16-28

Authors: Kannan A, Poongkunran C, Medina R, Ramanujam V, Poongkunran M, Balamuthusamy S

Abstract
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) on dialysis have an increased risk for cardiovascular mortality and morbidity secondary to occlusive coronary artery disease. Optimal revascularization strategy is unclear in this high-risk population. We have performed a meta-analysis to compare coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with ESRD and CKD. We searched PubMed, Ovid, MEDLINE, CINAHL, and EMBASE (1980-2013) and found 17 trials (N = 33,584) in the ESRD arm and 6 studies (n = 15,493) in the CKD arm. Two investigators independently collected the data. All the studies were retrospective trials. In the ESRD and CKD groups, we found significantly reduced early mortality with the PCI group with the odds ratio of 2.08 (1.90-2.26; P < 0.00001) and 2.55 (1.45-4.51; P = 0.001), respectively. Contrary to the early mortality results, we found decreased late mortality with the CABG group when compared with the PCI group [odds ratio: 0.86 (0.83-0.89; P < 0.000001) and 0.82 (0.76-0.88; P < 0.00001)] in the ESRD and CKD arm, respectively. When compared with PCI, there was decreased cardiovascular mortality with an odds ratio of 0.61 (0.40-0.92; P = 0.02) in patients who underwent CABG in ESRD population. Similar trends were observed in the incidence of myocardial infarction and repeat revascularization. There is a strong trend for decreased risk of stroke with PCI when compared with CABG in ESRD and CKD populations.

PMID: 24999748 [PubMed - indexed for MEDLINE]

Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion.

Wed, 01/30/2019 - 08:36
Related Articles

Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion.

Semin Dial. 2015 May-Jun;28(3):293-8

Authors: Balamuthusamy S, Kannan A, Thajudeen B, Ottley D, Jalandhara N

Abstract
Renovascular hypertension is a syndrome which encompasses the physiological response of the kidney to changes in renal blood flow and renal perfusion pressure. Such physiological changes can occur with renal artery occlusion irrespective of the severity of the lesion. We have analyzed hypertensive patients with mild renal artery stenosis and compared them to patients with no stenosis. Renal vein renin sampling from catheterization of the renal vein was performed in all these patients. Patients with mild stenosis had higher renal vein renin ratio (3.01 ± 1.5) than the patients with no stenosis (1.10 ± 0.29; p = 0.002). Patients with mild stenosis were also found to have higher diastolic blood pressure and renal artery resistive indices when compared to patients with no stenosis. We therefore conclude that mild stenosis can precipitate renin-mediated hypertension in renovascular stenosis and also emphasis that parameters pertinent to renal physiology need to be evaluated before considering treatment options in patients with renal artery stenosis and medical management with RAAS blockade is the preferred modality of therapy for patients with renin-mediated hypertension.

PMID: 24943669 [PubMed - indexed for MEDLINE]

Prognostic value of myocardial scar in atrial fibrillation.

Wed, 01/30/2019 - 08:36
Related Articles

Prognostic value of myocardial scar in atrial fibrillation.

J Am Coll Cardiol. 2014 May 20;63(19):2055

Authors: Kannan A, Balamuthusamy S

PMID: 24561137 [PubMed - indexed for MEDLINE]

Self-centering, split-tip catheter has better patency than symmetric-tip tunneled hemodialysis catheter: single-center retrospective analysis.

Wed, 01/30/2019 - 08:36
Related Articles

Self-centering, split-tip catheter has better patency than symmetric-tip tunneled hemodialysis catheter: single-center retrospective analysis.

Semin Dial. 2014 Sep-Oct;27(5):522-8

Authors: Balamuthusamy S

Abstract
The performance and safety of a new self-centering, split-tip hemodialysis tunneled catheter was compared with a symmetric-tip catheter. The new catheter has a greater separation between the arterial and venous tips, with dual apertures designed to permanently face the center of the blood vessel. The design is intended to improve dialysis efficiency by increasing flow rates while decreasing recirculation, fibrin sheath formation, thrombosis, and vessel wall occlusions. The study results indicated that the self-centering, split-tip catheter had statistically greater patency after 3 months with similar clearance, blood flow, and safety.

PMID: 24438081 [PubMed - indexed for MEDLINE]

Circulating adipocytokines and chronic kidney disease.

Wed, 01/30/2019 - 08:36
Related Articles

Circulating adipocytokines and chronic kidney disease.

PLoS One. 2013;8(10):e76902

Authors: Mills KT, Hamm LL, Alper AB, Miller C, Hudaihed A, Balamuthusamy S, Chen CS, Liu Y, Tarsia J, Rifai N, Kleinpeter M, He J, Chen J

Abstract
BACKGROUND: Adipokines have been associated with atherosclerotic heart disease, which shares many common risk factors with chronic kidney disease (CKD), but their relationship with CKD has not been well characterized.
METHODS: We investigated the association of plasma leptin, resistin and adiponectin with CKD in 201 patients with CKD and 201 controls without. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) or presence of albuminuria. Quantile regression and logistic regression models were used to examine the association between adipokines and CKD adjusting for multiple confounding factors.
RESULTS: Compared to controls, adjusted median leptin (38.2 vs. 17.2 ng/mL, p<0.0001) and adjusted mean resistin (16.2 vs 9.0 ng/mL, p<0.0001) were significantly higher in CKD cases. The multiple-adjusted odds ratio (95% confidence interval) of CKD comparing the highest tertile to the lower two tertiles was 2.3 (1.1, 4.9) for leptin and 12.7 (6.5, 24.6) for resistin. Median adiponectin was not significantly different in cases and controls, but the odds ratio comparing the highest tertile to the lower two tertiles was significant (1.9; 95% CI, 1.1, 3.6). In addition, higher leptin, resistin, and adiponectin were independently associated with lower eGFR and higher urinary albumin levels.
CONCLUSIONS: These findings suggest that adipocytokines are independently and significantly associated with the risk and severity of CKD. Longitudinal studies are warranted to evaluate the prospective relationship of adipocytokines to the development and progression of CKD.

PMID: 24116180 [PubMed - indexed for MEDLINE]

Myeloma light chain-induced renal injury in mice.

Wed, 01/30/2019 - 08:36
Related Articles

Myeloma light chain-induced renal injury in mice.

Nephron Exp Nephrol. 2010;116(2):e32-41

Authors: Khan AM, Li M, Balamuthusamy S, Maderdrut JL, Simon EE, Batuman V

Abstract
We investigated the effects of human light chain (LC) protein-overload in mice kidney to gain further insights into the molecular mechanisms involved in the pathogenesis of myeloma kidney. Intact male C57BL/6, 10- to 12-week-old mice were given daily intraperitoneal (i.p.) injections of 1 ml of human κ-LCs (1.5 mg/ml, low dose), or (100 mg/ml, high dose) to uninephrectomized mice for 2 weeks. Intact, sham-operated or uninephrectomized control animals were given the same volume (1 ml/day) of saline, human serum albumin (10 mg/ml) or bovine serum albumin (100 mg/ml) i.p. for 2 weeks in place of LCs. The low-dose LC-treated mice had human LCs in their urine and a significant increase in monocyte chemoattractant protein-1 (MCP-1) mRNA in the kidneys. Uninephrectomized mice treated with high-dose κ-LCs showed tubule casts, and foci of intracytoplasmic rhomboid crystals within the proximal tubules, along with cytoskeletal disruptions and alterations in the brush-border membrane, and high concentrations of human κ-LC were present in their sera. High-dose LC treatment also led to increases in serum creatinine and tumor necrosis factor-α levels, and marked increases in interleukin-6 and MCP-1 expression as well as cellular apoptosis in the kidneys. These studies demonstrate that myeloma LC overload over a range of LC concentrations in mice causes significant functional and morphological kidney injury. The model should be helpful in investigating pathophysiologic mechanisms and exploring therapeutic interventions for myeloma kidney and other LC-associated renal disorders.

PMID: 20588062 [PubMed - indexed for MEDLINE]

Pituitary adenylate cyclase-activating polypeptide prevents cisplatin-induced renal failure.

Wed, 01/30/2019 - 08:36
Related Articles

Pituitary adenylate cyclase-activating polypeptide prevents cisplatin-induced renal failure.

J Mol Neurosci. 2011 Jan;43(1):58-66

Authors: Li M, Balamuthusamy S, Khan AM, Maderdrut JL, Simon EE, Batuman V

Abstract
Cisplatin is widely used for cancer chemotherapy, but nephrotoxicity is a major dose-limiting side effect. Our recent studies in vitro have shown that pituitary adenylate cyclase-activating polypeptide (PACAP) ameliorated cisplatin nephrotoxicity and that the renoprotection with PACAP38 was mediated by the PAC(1) receptor and through the p53-dependent and -independent suppression of apoptosis of human renal proximal tubular epithelial cells. In the present studies, PACAP38 prevented the rise in blood urea nitrogen and serum creatinine in mice treated with cisplatin. Cisplatin-exposed mice treated with PACAP38 had relatively well-preserved tubular integrity, even when the treatment started 24 h after cisplatin exposure. PACAP38 also reduced plasma and kidney levels of tumor necrosis factor-α and restored collagen IV levels. The damage to mouse kidney tubules caused by cisplatin involved p53 accumulation and was partially reversed by treatment with PACAP38. PACAP38 ameliorates cisplatin-induced acute kidney injury even when treatment started 24 h after the onset of injury and increases tubular regeneration, which further facilitates restoration of kidney function in addition to its anti-apoptotic effects.

PMID: 20514524 [PubMed - indexed for MEDLINE]

Pituitary adenylate cyclase-activating polypeptide ameliorates cisplatin-induced acute kidney injury.

Wed, 01/30/2019 - 08:36
Related Articles

Pituitary adenylate cyclase-activating polypeptide ameliorates cisplatin-induced acute kidney injury.

Peptides. 2010 Apr;31(4):592-602

Authors: Li M, Balamuthusamy S, Khan AM, Maderdrut JL, Simon EE, Batuman V

Abstract
Cisplatin nephrotoxicity involves DNA damage, proinflammatory responses and apoptosis/necrosis of renal proximal tubular epithelial cells. Pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to protect kidneys from ischemic injury and light chain-induced damage by modulating inflammation. Confluent monolayer of HK-2 human renal cells were exposed to 50 microM cisplatin in the presence or absence of either PACAP38 or p53 siRNA. Mice injected with cisplatin were also treated with PACAP38 daily for 3 days. The damage to HK-2 cells caused by cisplatin involved the activation of p53, caspase-7, and poly (ADP-ribose) polymerase-1 (PARP-1). PACAP38 prevented the decrease in the apurinic/apyrimidinic endonuclease-1 by suppressing p53 activation and blocked the cleavage of caspase-7 and PARP-1 in cisplatin-exposed cells. PACAP also markedly inhibited cisplatin-induced apoptotic tubule cell death. Exposure to cisplatin significantly suppressed the expression of fibronectin and collagens I and IV, and altered the integrin repertoire of human renal tubule cells, while PACAP partially reversed the reduction of fibronectin, collagen IV, and the integrin subunits in cells exposed to cisplatin. Experiments with PACAP receptor antagonists and siRNA silencing of p53 showed that the renoprotection with PACAP was mediated by the PAC(1) receptor and through both p53-dependent and -independent suppression of apoptosis. PACAP was renoprotective in vivo and prevented the rise in blood urea nitrogen and creatinine in mice treated with cisplatin. These results suggest that p53 plays a pivotal role in decreased integrin-mediated extracellular matrix component expression in cisplatin-induced tubule cell apoptosis, and reveal a novel aspect of PACAP-mediated renoprotection.

PMID: 20034524 [PubMed - indexed for MEDLINE]