Encyclopedia
End-stage renal disease (ESRD) is a serious condition affecting a large part of the population and, as such, represents a considerable financial burden for the health sector. After kidney transplantation, dialysis is the best active treatment option for people with ESRD. A suitable type of vascular access has to be created to establish a connection between the circulation system of the patient and the haemodialysis cycle, in order to provide haemodialysis in ESRD patients. The efficiency of haemodialysis treatment relies on the functional status ofvascular access. Arteriovenous fistula (AVF) is the most efficient method, as it has a low risk of infection and mortality, and can ensure long-term functional access. However, maturation of an AVF is a complex process and is not well understood; significant numbers of AVF fail to develop sufficiently prior to their use for haemodialysis due to either lack of vessel maturation or spontaneous thrombosis. There are multiple blood markers and human factors that contribute to the maturation of AVF.
- Vascular access
- Haemodialysis
- Arteriovenous fistula
There are generally three types of vascular access (arteriovenous fistula, arteriovenous graft and central venous catheter) that can be used for haemodialysis[1]. Of these, the arteriovenous fistula (AVF) is considered to provide the best long-term functional vascular access[2],[3]. To ensure that dialysis therapy can be efficiently performed, all patients need a fully developed fistula that is appropriate for the process of cannulation. In order to achieve this, several stages have to be covered, namely, pre-ESRD treatment by a kidney specialist and early referral to vascular surgeons for the construction, development, and cannulation of a fistula by a dialysis specialist. Vascular surgeons are required to construct mature AVFs so as to ensure their successful maturation and proper functioning to withstand dialysis. AVFs are cheaper; last longer; have lower infection, morbidity, and mortality rates; and reduce the chances of repeat intervention[4]. An independent predictive factors may be beneficial in anticipating the rate of fistula maturation without the use of invasive tests and could be cost-effective [5]. Multiple factors are involved in the functional maturation of AVFs, such as age, gender, and blood markers. However, there are no consistent criteria that can be applied before creation of AVFs at present. Clinicians has to rely on clinical judgement and other investigatory parameters including a pre-operative duplex scan, which has a major role in determining the success of fistula maturation. Early fistula failure is usually due to thrombosis which can be triggered by haematoma, by low flow rates resulting from low blood pressure, or by a hypercoagulable state. On the other hand, progressive neointimal hyperplasia in the venous outflow system can lead to stenosis, which can cause late thrombosis of haemodialysis AVF. Impairment of endothelial function is associated with decreased arterial remodelling and final venous lumen diameter. AVF anastomoses need early proliferation of endothelial cells to restore the barrier, permeability, and biochemical monitoring roles of endothelial cells in managing vascular repair, local thrombosis, neointimal hyperplasia, and inflammation [6]. There is a need to identify the therapies that are best suited for clinical use in AVF dysfunction.
Figure1. Factors affecting the maturation of arteriovenous fistula (AVF) [7]
References
- Muhammad A. Siddiqui; Suhel Ashraff; Derek Santos; Robert Rush; Thomas E. Carline; Zahid Raza; Development of prognostic model for fistula maturation in patients with advanced renal failure. Renal Replacement Therapy 2018, 4, 1-9, 10.1186/s41100-018-0153-z.
- Muhammad A. Siddiqui; Suhel Ashraff; Thomas Carline; Maturation of arteriovenous fistula: Analysis of key factors. Kidney Research and Clinical Practice 2017, 36, 318-328, 10.23876/j.krcp.2017.36.4.318.
- Neil Dhoul; Olga Dmitrieva; Paul Stevens; Donal O’Donoghue; Simon De Lusignan; Quality achievement and disease prevalence in primary care predicts regional variation in renal replacement therapy (RRT) incidence: an ecological study. Nephrology Dialysis Transplantation 2011, 27, 739-746, 10.1093/ndt/gfr347.
- Muhammad A. Siddiqui; Suhel Ashraff; Derek Santos; Robert Rush; Thomas Carline; Zahid Raza; Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease. Kidney Research and Clinical Practice 2018, 37, 277-286, 10.23876/j.krcp.2018.37.3.277.
- Michael Allon; Current Management of Vascular Access. Clinical Journal of the American Society of Nephrology 2007, 2, 786-800, 10.2215/cjn.00860207.
- Abdulwahab N. Al-Isa; Lukman Thalib; Abayomi O. Akanji; Circulating markers of inflammation and endothelial dysfunction in Arab adolescent subjects: Reference ranges and associations with age, gender, body mass and insulin sensitivity. Atherosclerosis 2010, 208, 543-549, 10.1016/j.atherosclerosis.2009.07.056.
- Muhammad A. Siddiqui; Suhel Ashraff; Derek Santos; Thomas Carline; An overview of AVF maturation and endothelial dysfunction in an advanced renal failure. Renal Replacement Therapy 2017, 3, 1-6, 10.1186/s41100-017-0123-x.
