Vascular Access in Hemodialysis Patients

描述（由申请人提供） 血管通路手术及其随后的并发症代表了一个主要的 慢性血液透析患者的发病原因、住院和费用。 在美国，超过20%的血液透析患者的住院治疗是 与获取相关，获取发病率的年度成本估计为 接近10亿美元。动静脉瘘狭窄的发生率较低， 血栓形成，感染比移植物，并增加寿命，但大 新瘘管的比例从未充分成熟，可用于透析。 动静脉移植物容易发生频繁狭窄和血栓形成，需要多个 放射和手术干预，以保持其长期通畅。 透析导管受到低血流量和频繁血栓形成的困扰 影响透析的充分性，以及频繁的感染， 导致菌血症和危及生命的全身并发症。期间 在过去的几年里，申请人已经制定了一个多学科的方法， 血管通路，包括一个前瞻性的，计算机化的 数据库的所有访问程序。在这一合作努力的范围内， 申请人开发了血管通路的新方法， 改善了与血管相关的护理标准和总体临床结局 access. 该补助金的目标是优化申请人？追求的能力 关于旨在改善血管通路的新方法的研究 透析患者的结局。一些具体的问题， 主要包括：（1）如何提高新发动静脉瘘的比例 成熟到可以用于透析的程度(2)我们怎样才能减少 动静脉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？（四） 如何提高透析导管相关性的临床管理 菌血症？(5)如何预防透析的发生 导管相关感染 在进行本临床研究的过程中，候选人还将 指导肾病研究员开展以患者为导向的临床研究。 申请人将协助学员获得概念技能， 研究经验，以及追求成功的职业生涯所需的动力， 学术肾病。

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.