Mechanisms underlying vascular access dysfunction

Vascular access dysfunction remains the Achilles heel of dialysis (D), representing a challenging clinical problem. The primary patency rates are suboptimal and restenosis following angioplasty occurs frequently, leading to high morbidity and mortality rates in patients receiving hemodialysis (HD). Although the mechanisms of vascular injury to other organs have been well established, vascular injury leading to vascular access dysfunction in patients on hemodialysis has not. The uremic environment and the injury associated with hemodialysis contribute to the pathogenesis of vascular access dysfunction. This review summarizes recent literature on the mechanisms of injury leading to vascular access dysfunction.

Section editor:Joel Linden – Department of Medicine, University of Virginia, Charlottesville, VA, USA