New Insights into Dialysis Vascular Access: Introduction

Allon, Michael

doi:10.2215/cjn.01610216

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The uncontrolled growth of ECs and VSMCs at the graft-vein anastomosis leads to IH development at the connected junction, which accelerates graft failure. 48 To examine whether the ACMO-AVG could promote EC and VSMC adhesion, the exterior surfaces of trimmed strips of the graft were exposed to human umbilical vascular endothelial cells (HUVECs) and human vascular smooth muscle cells (hVSMCs) overnight at 37 °C. When compared to the number of HUVECs detected on the cell culture plate, a lower number of cells was detected on the surface of the ePTFE-AVG ( Fig.…”

Section: Resultsmentioning

confidence: 99%

The formulation and characterization of 3D printed grafts as vascular access for potential use in hemodialysis

et al. 2018

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Section: Resultsmentioning

confidence: 99%

The formulation and characterization of 3D printed grafts as vascular access for potential use in hemodialysis

et al. 2018

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“…Odds of all cause, cardiovascular, and infectious mortality are 3.7, 2.8, and 6.6, respectively, in patients who use tunneled catheters as compared to those who use AVFs . Even in the elderly, catheter use is associated with infection, hospitalization, and high mortality rates . Catheter use has declined to 19% among prevalent dialysis patients, likely because of educational efforts by dialysis facilities in response to reimbursement metrics set by CMS, but at the time of dialysis initiation up to 80% of patients are still using a tunneled catheter…”

Section: Current Gaps In Care Around Clinical and Psychosocial Risk Fmentioning

confidence: 99%

“…2,65 Even in the elderly, catheter use is associated with infection, hospitalization, and high mortality rates. [66][67][68] Catheter use has declined to 19% among prevalent dialysis patients, likely because of educational efforts by dialysis facilities in response to reimbursement metrics set by CMS, but at the time of dialysis initiation up to 80% of patients are still using a tunneled catheter. 7,11,16,65 Another risk factor for infectious complications in patients on hemodialysis relates to their nutritional resilience.…”

Section: Infectionsmentioning

confidence: 99%

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

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Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks. Barriers to improving hospitalization outcomes, especially as they relate to above risk categories, exist at multiple stakeholder levels and include: (1) dialysis facilities (strict shift changes, personnel challenges), (2) nephrologists (static dialysis prescriptions and protocols based on dialysis facility metrics), and (3) patients (lack of engagement and self-efficacy). System-level elements, such as payment models, help to propagate these barriers. In this article, we seek to shift the care paradigm discussion to patient trajectories and long-term outcomes, and to active engagement of patients as self-managers, through which we hope to impact on high inpatient resource utilization. We will also focus attention on the complex interplay of practices that have become acceptable care structures, but that may be deleterious to outcomes. Only after thorough consideration of these topics can we hope to impact on this important problem.

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Towards the Identification of Hemodynamic Parameters Involved in Arteriovenous Fistula Maturation and Failure: A Review

Franzoni

Walsh

2017

Cardiovasc Eng Tech

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Native arteriovenous fistulas have a high failure rate mainly due to the lack of maturation and uncontrolled neo-intimal hyperplasia development. Newly established hemodynamics is thought to be central in driving the fistula fate, after surgical creation. To investigate the effects of realistic wall shear stress stimuli on endothelial cells, an in vitro approach is necessary in order to reduce the complexity of the in vivo environment. After a systematic review, realistic WSS waveforms were selected and analysed in terms of magnitude, temporal gradient, presence of reversing phases (oscillatory shear index, OSI) and frequency content (hemodynamics index, HI). The effects induced by these waveforms in cellular cultures were also considered, together with the materials and methods used to cultivate and expose cells to WSS stimuli. The results show a wide heterogeneity of experimental approaches and WSS waveform features that prevent a complete understanding of the mechanisms that regulate mechanotransduction. Furthermore, the hemodynamics derived from the carotid bifurcation is the most investigated (in vitro), while the AVF scenario remains poorly addressed. In conclusion, standardisation of the materials and methods employed, as well as the decomposition of realistic WSS profiles, are required for a better understanding of the hemodynamic effects on AVF outcomes. This standardisation may also lead to a new classification of WSS features according to the risk associated with vascular dysfunction.

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New Insights into Dialysis Vascular Access: Introduction

Cited by 5 publications

References 23 publications

The formulation and characterization of 3D printed grafts as vascular access for potential use in hemodialysis

The formulation and characterization of 3D printed grafts as vascular access for potential use in hemodialysis

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Towards the Identification of Hemodynamic Parameters Involved in Arteriovenous Fistula Maturation and Failure: A Review

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