REVIEWS   

Minerva Urologica e Nefrologica 2010 December;62(4):387-410

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

The use of new concepts in vascular physiology and pharmacology to improve hemodialysis access outcomes

Diskin C. J. ✉

Departments of Hypertention, Nephrology, Dialysis and Transplantion, Auburn University, Opelika, AL, USA

Greater insight into vascular pathophysiology and intimal hyperplasia has resulted in observational studies that suggest that interventions which decrease inflammatory mediators, improve endothelial function and inhibit smooth muscle migration and proliferation may be of benefit in improving hemodialysis vascular access survival. Longer dialysis times may also reduce inflammatory mediators and restore vascular sensitivity to endothelium dependent relaxation factor. In contrast, the common procedure of angioplasty is the experimental model to develop intimal hyperplasia and stenosis, while the efficacy of stents to prevent that stenosis in hemodialysis accesses remains controversial. Common drugs that interfere with metalloproteinases may prevent aneurysm formation while avoiding drugs that aid quorum sensing and using drugs that interfere with it may prevent biofilm infection in hemodialysis vascular catheters. Large prospective randomized studies will be needed to determine the true benefit.