Challenges and novel therapies for vascular access in haemodialysis.
Challenges and novel therapies for vascular access in haemodialysis.
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DOI：
10.1038/s41581-020-0333-2
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Roy-Chaudhury P
中科院分区：
文献类型：
--
作者：
Lawson JH;Niklason LE;Roy-Chaudhury P
护理标准的进步延长了肾衰竭患者的预期寿命。然而，血液透析慢性血管通路的选择-肾脏替代治疗的重要组成部分-几十年来一直保持不变。与当前血管通路并发症相关的高发病率和死亡率突出了对血管通路新技术的未满足的临床需求，并正在推动血管通路护理的创新。器械、生物学方法和新型入路技术的发展带来了新的方法来控制瘘的几何形状和操纵血管内皮的潜在细胞和分子通路，并通过使用外部机械方法影响瘘的成熟和形成。动静脉移植材料的创新范围从移植管腔的微小修改到完全新颖的生物工程移植物的创建。甚至已经采取步骤来创建用于治疗患有中央静脉狭窄的患者的新设备。然而，这些新兴疗法面临着困难的障碍，真正创造性的血管通路方法需要资源，包括精心设计的临床试验，与监管机构的频繁互动，干预教育和足够的资金。此外，肾衰竭患者的异质性表明，在当前环境下，有效血管通路的“一刀切”方法不太可能可行。
Advances in standards of care have extended the life expectancy of patients with kidney failure. However, options for chronic vascular access for haemodialysis — an essential part of kidney replacement therapy — have remained unchanged for decades. The high morbidity and mortality associated with current vascular access complications highlights an unmet clinical need for novel techniques in vascular access and is driving innovation in vascular access care. The development of devices, biological approaches and novel access techniques has led to new approaches to controlling fistula geometry and manipulating the underlying cellular and molecular pathways of the vascular endothelium, and influencing fistula maturation and formation through the use of external mechanical methods. Innovations in arteriovenous graft materials range from small modifications to the graft lumen to the creation of completely novel bioengineered grafts. Steps have even been taken to create new devices for the treatment of patients with central vein stenosis. However, these emerging therapies face difficult hurdles, and truly creative approaches to vascular access need resources that include well-designed clinical trials, frequent interaction with regulators, interventionalist education and sufficient funding. In addition, the heterogeneity of patients with kidney failure suggests it is unlikely that a ‘one-size-fits-all’ approach for effective vascular access will be feasible in the current environment.
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影响因子：
158.5
作者：
BRESCIA, MJ;CIMINO, JE;HURWICH, BJ
通讯作者：
HURWICH, BJ
影响因子：
19.6
作者：
Beathard, GA;Arnold, P;Litchfield, T
通讯作者：
Litchfield, T
影响因子：
4.3
作者：
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通讯作者：
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影响因子：
4.3
作者：
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通讯作者：
Fabian, TC
影响因子：
13.3
作者：
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通讯作者：
Metcalfe, W.