Innovations in vascular access for hemodialysis

Agarwal, Anil; Haddad, Nabil J.; Vachharajani, Tushar J.; Asif, Arif

doi:10.1016/j.kint.2018.11.046

Cited by 52 publications

(44 citation statements)

References 75 publications

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“…The global prevalence of chronic kidney disease (CKD), especially in the elderly population, is expected to grow sharply in the future. 2,3 Over the past 60 years, hemodialysis vascular access options have largely remained restricted to AVF, AVG, and central venous catheter (CVC). AVF remains the access preferred over AVG because of its lower infection rate, fewer thrombosis events, and higher long-term patency.…”

Section: Vascular Access Burdenmentioning

confidence: 99%

New Devices and Technologies for Hemodialysis Vascular Access: A Review

Vachharajani

Taliercio

Anvari

2021

American Journal of Kidney Diseases

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In the United States, hemodialysis remains the most common treatment modality for kidney failure, chosen by almost 90% of incident patients. A functioning vascular access is key to providing adequate hemodialysis therapy. Recently, major innovations in devices and technology for hemodialysis vascular access care have rapidly changed the landscape. Novel endovascular devices for creation of arteriovenous fistulas may offer a solution to the barriers encountered in initiating maintenance hemodialysis with a permanent vascular access rather than a central venous catheter (CVC). Furthermore, in the prevalent hemodialysis population, the minimally invasive endovascular arteriovenous fistula procedure should help improve long wait times for vascular access creation, which remains a major barrier to reducing CVC dependence. Bioengineered grafts are being developed and may offer another option to polytetrafluoroethylene grafts. Early studies with these biocompatible grafts are promising, as additional studies continue to evaluate their clinical outcomes in comparison to cryopreserved or synthetic options. Prolonging the vascular access patency with appropriate use of devices such as drug-coated balloons and stent grafts may complement the novel techniques of creating arteriovenous access. Finally, innovative solutions to treat stenosed and occluded thoracic central veins can provide an approach to creating a vascular access and allow patients with exhausted vasculature to remain on hemodialysis. The robust developments in hemodialysis vascular access are likely to change practice patterns in the near future.Complete author and article information provided before references.

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Section: Vascular Access Burdenmentioning

confidence: 99%

New Devices and Technologies for Hemodialysis Vascular Access: A Review

Vachharajani

Taliercio

Anvari

2021

American Journal of Kidney Diseases

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“…Haemodialysis is the prevalent dialysis modality for over 2 million people worldwide [ 12 ]. Although strongly advocated in clinical guidelines, timing the formation and development of a functional AVA for haemodialysis is logistically challenging and associated with a high failure rate [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

The arteriovenous access stage (AVAS) classification

Baláž

Hanko

Magowan

et al. 2020

Clinical Kidney Journal

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Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

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“…However, they can promote microbial resistance and exhibit toxicity. These solutions are more effective against gram‐negative organisms than the gram‐positives 1 …”

Section: Lock Solutions For Hd Cathetersmentioning

confidence: 99%

“…Hemodialysis catheters serve as one of the vascular access devices for hemodialysis (HD) patients and are included in the major cost of HD treatment 1 . In 1929, Werner Forssmann entered the right antecubital vein in his own body via the ureter catheter and reached the right atrium.…”

Section: Introductionmentioning

confidence: 99%

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

et al. 2020

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Insertion of a central venous catheter is one of the most common invasive procedures applied in hemodialysis therapy for end‐stage renal disease. The most important complication of a central venous catheter is catheter‐related infections that increase hospitalization and duration of intensive care unit stay, cost of treatment, mortality, and morbidity rates. Pathogenic microorganisms, such as, bacteria and fungi, enter the body from the catheter insertion site and the surface of the catheter can become colonized. The exopolysaccharide‐based biofilms from bacterial colonies on the surface are the main challenge in the treatment of infections. Catheter lock solutions and systemic antibiotic treatment, which are commonly used in the treatment of hemodialysis catheter‐related infections, are insufficient to prevent and terminate the infections and eventually the catheter needs to be replaced. The inadequacy of these approaches in termination and prevention of infection revealed the necessity of coating of hemodialysis catheters with bactericidal and/or antiadhesive agents. Silver compounds and nanoparticles, anticoagulants (e.g., heparin), antibiotics (e.g., gentamicin and chlorhexidine) are some of the agents used for this purpose. The effectiveness of few commercial hemodialysis catheters that were coated with antibacterial agents has been tested in clinical trials against catheter‐related infections of pathogenic bacteria, such as Staphylococcus aureus and Staphylococcus epidermidis with promising results. Novel biomedical materials and engineering techniques, such as, surface micro/nano patterning and the conjugation of antimicrobial peptides, enzymes, metallic cations, and hydrophilic polymers (e.g., poly [ethylene glycol]) on the surface, has been suggested recently.

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Innovations in vascular access for hemodialysis

Cited by 52 publications

References 75 publications

New Devices and Technologies for Hemodialysis Vascular Access: A Review

New Devices and Technologies for Hemodialysis Vascular Access: A Review

The arteriovenous access stage (AVAS) classification

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

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