title: Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies.
abstract: Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population at a cost of over USD 1 billion per annum. Most hemodialysis grafts fail due to a venous stenosis (venous neointimal hyperplasia) which then results in thrombosis of the graft. Despite the magnitude of the clinical problem there are currently no effective therapies for this condition. The current review (a) describes the pathogenesis and pathology of venous stenosis in dialysis access grafts and (b) discusses the development and application of novel therapeutic interventions for this difficult clinical problem. Special emphasis is laid on the fact that PTFE dialysis access grafts could be the ideal clinical model for testing out novel local therapies to block neointimal hyperplasia.
authors.affiliation: University of Cincinatti Medical Center, Ohio 45267, USA. roychap@ucmail.uc.edu
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
authors.forename: Burnett S
authors.initials: BS
authors.lastname: Kelly
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhang
authors.forename: Ashwath
authors.initials: A
authors.lastname: Narayana
authors.forename: Pankaj
authors.initials: P
authors.lastname: Desai
authors.forename: Murad
authors.initials: M
authors.lastname: Melham
authors.forename: Heather
authors.initials: H
authors.lastname: Duncan
authors.forename: Sue C
authors.initials: SC
authors.lastname: Heffelfinger
mesh_terms: D000818:Animals; D002404:Catheterization / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D006965:Hyperplasia / Q000209:etiology / Q000473:pathology / Q000628:therapy; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation