Document Detail


Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint.
MedLine Citation:
PMID:  16565259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. The major cause of hemodialysis vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia. Despite the magnitude of the clinical problem, however, there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. The reasons for this are two-fold. First there has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. Second, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This review therefore (1) briefly examines the different forms of hemodialysis vascular access that are available, (2) describes the pathology and pathogenesis of hemodialysis vascular access dysfunction in both polytetrafluoroethylene grafts and native arteriovenous fistulae, (3) reviews recent concepts about the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction, (4) summarizes novel experimental and clinical therapies that could potentially be used in the setting of hemodialysis vascular access dysfunction, and, finally, (5) offers some broad guidelines for future innovative translational and clinical research in this area that hopefully will reduce the huge clinical morbidity and economic costs that are associated with this condition.
Authors:
Prabir Roy-Chaudhury; Vikas P Sukhatme; Alfred K Cheung
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Review    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  17     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-27     Completed Date:  2006-09-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1112-27     Citation Subset:  IM    
Affiliation:
Division of Nephrology, MSB G-251, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0585. prabir.roychaudhury@uc.edu
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MeSH Terms
Descriptor/Qualifier:
Angioplasty
Arteriovenous Shunt, Surgical / adverse effects*,  methods
Blood Vessel Prosthesis / adverse effects
Blood Vessels / pathology
Catheters, Indwelling / adverse effects*
Constriction, Pathologic
Cryosurgery
Drug Delivery Systems
Gene Therapy
Humans
Hyperplasia
Photochemotherapy
Polytetrafluoroethylene
Prosthesis Failure
Radiotherapy
Renal Dialysis / adverse effects*
Stents
Grant Support
ID/Acronym/Agency:
R01 DK 61689/DK/NIDDK NIH HHS; R01 HL 67646/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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