Vascular Access in Hemodialysis Patients

描述(由申请人提供) 血管通路程序及其随后的并发症是一个主要的 慢性血液透析患者的发病原因、住院时间和费用。 在美国，超过20%的血液透析患者住院治疗是 与获取相关，每年获取致残率的成本估计为 接近10亿美元。动静脉瘘的狭窄发生率较低， 血栓形成和感染比移植物，寿命长，但大 新造瘘管的比例永远不会足够成熟，不能用于透析。 动静脉桥容易频繁狭窄和血栓形成，需要多次 放射和外科干预以维持其长期通畅性。 透析导管存在低血流量和频繁的血栓形成。 这损害了透析的充分性，以及频繁的感染 导致菌血症和危及生命的全身并发症。在.期间 在过去的几年里，申请者发展了一种多学科的方法来 他机构的血管通道，包括未来的，计算机化的 所有访问程序的数据库。在这一合作努力的背景下， 申请人开发了新的血管通路方法，具有 改善了与血管相关的护理标准和总体临床结果 进入。 这笔助学金的目标是优化申请者S的追求能力。 关于旨在改善血管通路的新方法的调查 透析患者的预后。一些具体的问题将是 解决的问题包括：(1)如何增加新的动静脉瘘的比例 足够成熟以用于透析？(2)我们如何才能减少 移植物狭窄和血栓形成的频率？(3)我们如何改善 血液流动和减少透析导管血栓形成的频率？(4) 如何提高透析导管相关的临床管理水平 菌血症？(5)如何预防透析的发生 导管相关性感染？ 在进行这项临床研究的过程中，候选人还将 导师肾脏病研究员在进行以患者为中心的临床研究。 申请者将帮助学员获得概念技能， 研究经验和追求成功职业生涯所需的动力 学术肾脏学。

DESCRIPTION (provided by applicant) Vascular access procedures and their subsequent complications represent a major cause of morbidity, hospitalization and cost for chronic hemodialysis patients. Over 20% of hospitalizations in hemodialysis patients in the United States are access-related, and the annual cost of access morbidity has been estimated at close to $1 billion. A-V fistulas have a lower incidence of stenosis, thrombosis, and infection than grafts, and increased longevity, but a large proportion of new fistulas never mature adequately to be usable for dialysis. A-V grafts are prone to frequent stenosis and thrombosis, requiring multiple radiologic and surgical interventions to maintain their long-term patency. Dialysis catheters are plagued with low blood flows and frequent thrombosis that impair the adequacy of dialysis, as well as frequent infections that result in bacteremia and life-threatening systemic complications. During the past few years the applicant has developed a multidisciplinary approach to vascular access at his institution, including a prospective, computerized database of all access procedures. In the context of this collaborative effort, the applicant has developed novel approaches to vascular access that have improved the standard of care and overall clinical outcomes related to vascular access. The goal of this grant is to optimize the applicant?s ability to pursue investigations regarding novel approaches aimed at improving vascular access outcomes in dialysis patients. Some of the specific questions that will be addressed include: (1) How can we increase the proportion of new A-V fistulas that mature adequately to be usable for dialysis? (2) How can we decrease the frequency of stenosis and thrombosis of A-V grafts? (3) How can we improve the blood flows and decrease the frequency of thrombosis of dialysis catheters? (4) How can we improve the clinical management of dialysis catheter-associated bacteremia? (5) How can we prevent the occurrence of dialysis catheter-associated infections? In the process of performing this clinical research, the candidate will also mentor Nephrology Fellows in the conduct of patient-oriented clinical research. The applicant will assist the trainees in acquiring the conceptual skills, research experience, and motivation required to pursue a successful career in Academic Nephrology.