Understanding the pathophysiology of hemodialysis access problems as a prelude to developing innovative therapies.
Maintenance of a functioning vascular access for hemodialysis is a major challenge for nephrologists, vascular surgeons and--most importantly--the patients themselves. Greater insight into the pathophysiology of access thrombosis, stenosis, aneurysm formation, fistula maturation failure and catheter infection will aid the development of innovative ways to prevent and treat these complications. According to the results of observational studies, agents that decrease the release of inflammatory mediators, improve endothelial function, and inhibit the migration and proliferation of vascular smooth-muscle cells might improve the maturation and survival of native hemodialysis fistulas and synthetic hemodialysis grafts by reducing the risks of thrombosis and stenosis. Currently available drugs that interfere with metalloproteinases could prevent the formation of aneurysms, and bacterial quorum sensing offers a promising target for the prevention of biofilm infection in hemodialysis catheters.
Diskin
Charles J
CJ
Hypertension, Nephrology, Dialysis and Transplantation Clinic, Auburn University, Opelika, AL 36801, USA. hndt512@bellsouth.net
Stokes
Thomas J
TJ
Dansby
Linda M
LM
Radcliff
Lautrec
L
Carter
Thomas B
TB
D001164:Arteriovenous Fistula / Q000517:prevention & control*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000473:pathology; D004866:Equipment Contamination / Q000517:prevention & control; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D035703:Therapies, Investigational / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology