Causes of hemodialysis access failure

Area of Science:

• Nephrology
• Vascular Surgery
• Biomedical Engineering

Background:

• Complications of hemodialysis access are a major challenge for patients receiving renal replacement therapy.
• Native arteriovenous fistulas are preferred for their longevity and low complication rates, but not all patients are candidates.
• Expanded polytetrafluoroethylene (ePTFE) grafts are used when fistulas are not feasible.

Purpose of the Study:

• To recognize the causes of hemodialysis access loss.
• To identify factors contributing to early and late complications.
• To explore potential mechanisms disrupting the balance of hemostasis within arteriovenous conduits.

Main Methods:

• Review of existing literature on hemodialysis access complications.
• Analysis of causes for failure in native arteriovenous fistulas and ePTFE grafts.
• Discussion of thrombosis and infection as primary causes of access morbidity.

Main Results:

• Thrombosis is the leading cause of failure for both native fistulas and ePTFE grafts.
• ePTFE grafts are also susceptible to infection, pseudoaneurysms, and hematomas.
• Thrombosis in ePTFE grafts is often linked to stenosis but can also occur in low-flow states, potentially due to disrupted endothelial hemostasis.
• Staphylococcus aureus is a common pathogen in access infections, with no clear consensus on optimal treatment.

Conclusions:

• Effective interventions for hemodialysis access complications require a thorough understanding of their causes.
• Thrombosis and infection represent significant challenges in maintaining functional hemodialysis access.
• Further research is needed to address the complexities of access-related morbidity, particularly concerning infection management.