RESEARCH ARTICLE


Novel Therapeutic Paradigms to Treat Hemodialysis Access Dysfunction



Lalathaksha Kumbar* , 1, Jian Li1, Hafeez Alsmaan1, Anatole Besarab2
1 Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit MI, USA; Wayne State School of Medicine, Detroit MI, USA
2 Division of Nephrology, Stanford University, Stanford, California, USA


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© Kumbar et al.; Licensee Bentham Open.

* Address correspondence to this author at the Division of Nephrology and Hypertension, Henry Ford Hospital, CFP 507, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Tel: 313-916-2711; E-mail: lkumbar1@hfhs.org


Abstract

Vascular access dysfunction continues to be a major factor contributor to the morbidity and mortality of hemodialysis patient. Percutaneous intervention has been the central therapeutic modality used to treat dialysis vascular access dysfunction with limited success. Vascular biology research has shed considerable light on the pathophysiologic processes that lead to the development of neointimal hyperplasia, the culprit lesion for vascular access dysfunction, suggesting possible newer novel therapeutic interventions. In this review we discuss; (1) recent advances in the utilization of image based predictive medicine in improving access type selection prior to access creation; (2) current and promising treatment modalities including brachytherapy, gene therapy and pharmacotherapy for prevention of neointimal hyperplasia; (3) alternate imaging modalities during percutaneous endovascular interventions. Though novel therapeutic interventions are evolving, robust clinical studies to identify optimal therapeutic method are needed. A combination of evidenced based interventions from pre access creation up until final abandonment of vascular access is worthy of exploration.

Keywords: Angioplasty balloons, antiproliferative agents, arteriovenous fistula, predictive medicine, ultrasound guided angioplasty.