Understanding the pathophysiology of hemodialysis access problems as a prelude to developing innovative therapies

Understanding the pathophysiology of hemodialysis access problems as a prelude to developing innovative therapies
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了解血液透析通路问题的病理生理学是开发创新疗法的前奏

DOI:
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发表时间:
2008
期刊:
Nature Clinical Practice Nephrology
影响因子:
--
通讯作者:
T. Carter
T. Carter
中科院分区:
--
文献类型:
--
作者:
C. Diskin;T. Stokes;L. Dansby;L. Radcliff;T. Carter

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维持血液透析血管通路的功能是肾脏科医生、血管外科医生和最重要的患者本身面临的主要挑战。对通路血栓形成、狭窄、动脉瘤形成、瘘管成熟失败和导管感染的病理生理学的更深入了解将有助于开发预防和治疗这些并发症的创新方法。根据观察性研究的结果,减少炎症介质释放、改善内皮功能、抑制血管平滑肌细胞迁移和增殖的药物可能通过降低血栓形成和狭窄的风险来改善自体血液透析瘘和合成血液透析移植物的成熟和存活。目前可用的干扰金属蛋白酶的药物可以防止动脉瘤的形成,细菌群体感应为预防血液透析导管中的生物膜感染提供了一个有前途的目标。
Maintenance of a functioning vascular access for hemodialysis is a major challenge for nephrologists, vascular surgeons and—most importantly—the patients themselves. Greater insight into the pathophysiology of access thrombosis, stenosis, aneurysm formation, fistula maturation failure and catheter infection will aid the development of innovative ways to prevent and treat these complications. According to the results of observational studies, agents that decrease the release of inflammatory mediators, improve endothelial function, and inhibit the migration and proliferation of vascular smooth-muscle cells might improve the maturation and survival of native hemodialysis fistulas and synthetic hemodialysis grafts by reducing the risks of thrombosis and stenosis. Currently available drugs that interfere with metalloproteinases could prevent the formation of aneurysms, and bacterial quorum sensing offers a promising target for the prevention of biofilm infection in hemodialysis catheters.
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