Abstract:
:In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are essential. Inadequate vascular remodeling and neointimal hyperplasia resulting in stenosis and frequently thrombosis are critical to the pathogenesis of access failure. Systemic medical therapies with pleiotropic effects including antiplatelet agents, omega-3 polyunsaturated fatty acids (fish oils), statins, and inhibitors of the renin-angiotensin-aldosterone system (RAAS) may reduce vascular access failure by promoting vascular access maturation and reducing stenosis and thrombosis through antiproliferative, antiaggregatory, anti-inflammatory and vasodilatory effects. Despite such promise, the results of retrospective analyses and randomized controlled trials of these agents on arteriovenous fistula and graft outcomes have been mixed. This review describes the current understanding of the pathogenesis of arteriovenous fistula and graft failure, the biological effects of antiplatelet agents, fish oil supplementation, RAAS blockers and statins that may be beneficial in improving vascular access survival, results from clinical trials that have investigated the effect of these agents on arteriovenous fistula and graft outcomes, and it explores future therapeutic approaches combining these agents with novel treatment strategies.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Viecelli AK,Mori TA,Roy-Chaudhury P,Polkinghorne KR,Hawley CM,Johnson DW,Pascoe EM,Irish ABdoi
10.1111/sdi.12658subject
Has Abstractpub_date
2018-05-01 00:00:00pages
244-257issue
3eissn
0894-0959issn
1525-139Xjournal_volume
31pub_type
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journal_title:Seminars in dialysis
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pub_type: 杂志文章,多中心研究
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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更新日期:2012-11-01 00:00:00
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pub_type: 杂志文章
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