Challenges and novel therapies for vascular access in haemodialysis.

Journal Article (Journal Article;Review)

Advances in standards of care have extended the life expectancy of patients with kidney failure. However, options for chronic vascular access for haemodialysis - an essential part of kidney replacement therapy - have remained unchanged for decades. The high morbidity and mortality associated with current vascular access complications highlights an unmet clinical need for novel techniques in vascular access and is driving innovation in vascular access care. The development of devices, biological approaches and novel access techniques has led to new approaches to controlling fistula geometry and manipulating the underlying cellular and molecular pathways of the vascular endothelium, and influencing fistula maturation and formation through the use of external mechanical methods. Innovations in arteriovenous graft materials range from small modifications to the graft lumen to the creation of completely novel bioengineered grafts. Steps have even been taken to create new devices for the treatment of patients with central vein stenosis. However, these emerging therapies face difficult hurdles, and truly creative approaches to vascular access need resources that include well-designed clinical trials, frequent interaction with regulators, interventionalist education and sufficient funding. In addition, the heterogeneity of patients with kidney failure suggests it is unlikely that a 'one-size-fits-all' approach for effective vascular access will be feasible in the current environment.

Full Text

Duke Authors

Cited Authors

  • Lawson, JH; Niklason, LE; Roy-Chaudhury, P

Published Date

  • October 2020

Published In

Volume / Issue

  • 16 / 10

Start / End Page

  • 586 - 602

PubMed ID

  • 32839580

Pubmed Central ID

  • 32839580

Electronic International Standard Serial Number (EISSN)

  • 1759-507X

Digital Object Identifier (DOI)

  • 10.1038/s41581-020-0333-2

Language

  • eng

Conference Location

  • England