Managing venous stenosis in vascular access for haemodialysis

The prevalence of end-stage renal disease in Singapore is high and rising with some 2,700 patients requiring haemodialysis in the year 2004. In tandem with the increasing prevalence of diabetes mellitus, the number of dialysis patients is projected to rise to nearly 6,000 in the year 2010, adding to the national healthcare costs. Diabetic nephropathy accounts for about 40 percent of patients starting dialysis in Singapore. There have been few studies regarding vascular access for haemodialysis, despite its great demand in the local population. These vascular access channels are far from perfect, and provide great challenges for the vascular surgeons, nephrologists and interventional radiologists on a constant basis. The concomitant vasculopathies in diabetic patients also increase the risk of morbidity related to vascular access interventions. This paper will review the current state of interventions and research associated with managing venous stenosis in renal vascular access for haemodialysis.