scholarly journals Rationale and Trial Design of MesEnchymal Stem Cell Trial in Preventing Venous Stenosis of Hemodialysis Vascular Access Arteriovenous Fistula (MEST AVF Trial)

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005182021
Author(s):  
Ameet K. Piryani ◽  
Sreenivasulu Kilari ◽  
Edwin Takahashi ◽  
Randall R. DeMartino ◽  
Jay Mandrekar ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Vascular Access ◽  
Trial Design ◽  
Phase 1 ◽  
Neointimal Hyperplasia ◽  
Ongoing Trial ◽  
Arteriovenous Fistulas ◽  
Venous Stenosis ◽  
Hemodialysis Vascular Access ◽  
Fistula Maturation

Background: Hemodialysis arteriovenous fistulas (AVFs) are the preferred vascular access for patients on hemodialysis. In the Hemodialysis Fistula Maturation Study, 43.7% of the patients achieved unassisted maturation of their fistula without needing an intervention. Venous neointimal hyperplasia (VNH) and subsequent venous stenosis (VS) is responsible for lack of maturation. There are no therapies that can prevent VNH/VS formation. The goal of this paper is to present the background, rationale, and trial design of an innovative phase 1 / 2 clinical study that is investigating the safety of autologous adipose derived mesenchymal stem cells (AMSCs) delivered locally to the adventitia of newly created upper extremity radiocephalic (RCF) or brachiocephalic fistula (BCF). Methods: The rationale and pre-clinical studies used to obtain a physician sponsored investigational new drug trial (IND) are discussed. The trial design and endpoints are discussed. Results: This is ongoing trial which will complete this year. Conclusion: This is a phase 1 / 2 single center, randomized trial which will investigate safety and efficacy of autologous AMSCs in promoting maturation in new upper extremity AVFs.

Abstract 466: CX3CR1 Down Regulation Reduces Venous Neointimal Hyperplasia Formation in a Murine Hemodialysis Vascular Access Model

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Binxia Yang ◽  
Sreenivaslisu Kilari ◽  
Deborah L McCall ◽  
John Broadwater ◽  
Steven Kerr ◽  
...  
Keyword(s):  
Cell Density ◽  
Vascular Access ◽  
Jugular Vein ◽  
Neointimal Hyperplasia ◽  
Genetically Engineered ◽  
Vehicle Group ◽  
Immunohistochemistry Analysis ◽  
Hemodialysis Vascular Access ◽  
Histology And Immunohistochemistry ◽  
Hemodialysis Arteriovenous Fistula

Introduction: Venous neointimal hyperplasia (VNH) is a major cause of hemodialysis arteriovenous fistula (AVF) vascular access failure. CX3CR1 mediates macrophage infiltration into the vasculature. Mice were used which had been genetically engineered to knock in the human CX3CR1 gene. Hypothesis: The hypothesis to be tested is that increased CX3CR1 gene expression results in VNH formation associated with AVF. Methods: We used 50 CX3CR1 knock in mice which were divided into 2 groups: 1. CX3CR1 antibody (30 mg/kg administered intraperitoneally two times per week) or vehicle (equal amount of volume used for CX3CR1 antibody administered intraperitoneally). AVFs were created by connecting the carotid artery to ipsilateral jugular vein 28 days after nephrectomy was performed to induce chronic kidney disease. Histology and Immunohistochemistry analysis at the outflow vein of AVF were performed to assess the pathological changes. Results: There was a significant decrease in neointima area in the outflow veins of AVF in CX3CR1 antibody group compared to the vehicle group at day 28 (43085 ± 12678 vs. 58963.4 ± 9273 μm 2 , P<0.05). There was a significant decrease in the ratio of neointima/media+adventitia area in the outflow veins of AVF in CX3CR1 antibody group compared to the vehicle group at day 28 (0.34 ± 0.1 vs. 0.61 ± 0.1, P<0.05). Cell density in neointima area in CX3CR1 group outflow veins was significantly lower than the vehicle group at day 14 (9600 ± 1000 vs. 13000 ± 3000 /mm 2 , P<0.01). There was a significant decrease in the average CD68-positive cell density in the CX3CR1 group outflow veins compared to the vehicle group (0.96 ± 0.34 vs.15.9 ±10, P<0.001) at day 14. Conclusion: Decreasing CX3CR1 significantly reduces macrophages infiltration and results in a significant reduction in VNH. This study provides a rationale for using CX3CR1 antibody in reducing VNH formation.

scholarly journals Advanced Stent Graft Treatment of Venous Stenosis Affecting Hemodialysis Vascular Access: Case Illustrations

2016 ◽  
Vol 33 (01) ◽  
pp. 039-045 ◽  
Author(s):  
Darshan Patel ◽  
R. Lokken ◽  
James Bui ◽  
Andrew Lipnik ◽  
Ron Gaba ◽  
...  
Keyword(s):  
Stent Graft ◽  
Vascular Access ◽  
Venous Stenosis ◽  
Hemodialysis Vascular Access

Hemodialysis Vascular Access: Rising Costs As A Surrogate Marker For Patency and Function of Arteriovenous Fistulas

2016 ◽  
Vol 34 ◽  
pp. 27
Author(s):  
Zachary M. Feldman ◽  
Lisa B. Liu ◽  
Stephen D. Abramowitz ◽  
Peter L. Faries ◽  
Michael L. Marin ◽  
...  
Keyword(s):  
Vascular Access ◽  
Surrogate Marker ◽  
Arteriovenous Fistulas ◽  
Hemodialysis Vascular Access ◽  
And Function

Sex, race, and hemodialysis vascular access processes

2017 ◽  
Vol 18 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Rita L. McGill ◽  
Eduardo Lacson
Keyword(s):  
Vascular Access ◽  
Cox Regression ◽  
Demographic Variables ◽  
Success Rates ◽  
Arteriovenous Fistulas ◽  
Hemodialysis Vascular Access ◽  
Black Patients ◽  
Differential Ability ◽  
Access Surgery ◽  
Central Catheters

Purpose Hemodialysis (HD) patients who are female or black receive fewer arteriovenous fistulas (AVF) and more grafts (AVG). We evaluated race- and sex-based differences for three process exposures: access surgery, peripherally-inserted central catheters (PICCs), and vascular imaging. Methods US Renal Data System with linked Medicare claims for patients initiating HD between April 2010 – December 2011 were used to identify PICC placement, imaging, AVF and AVG surgeries, and the vascular accesses in use at individual HD treatments. Poisson, logistic, and Cox regression models adjusted for clinical and demographic variables were used to evaluate relationships between process exposures, vascular access outcomes, and sex. Results Among 18,883 individuals initiating HD with catheters with at least one surgical claim for AVF or AVG, women had 16% more PICC and 5% more imaging (p = 0.002), were 43% less likely to have AVF surgery and 68% more likely to have AVG surgery (p<0.001). The odds of AVF surgery producing a working AVF were 18% lower and of AVG surgery producing a working AVG 38% higher (p<0.001). Black patients had 24% more PICCs and 12% more imaging, were 48% less likely to have AVF surgery and 84% more likely to have AVG surgery (p<0.001). The odds of achieving a working AVF were 8% lower and of a working AVG were 38% higher. The hazard of future catheter use after AVF creation was 25% higher for women (p<0.001), but did not differ by race. Conclusions Divergences in vascular access by race and sex were partly related to differential process exposures. Black and female patients had more AVG and less AVF surgery, and more PICC and imaging. Success rates were lower for AVF surgery and higher for AVG surgery. Further work is needed to determine whether choices of process exposures arise from differential ability to detect veins on physical examination.

scholarly journals Minimizing Hemodialysis Vascular Access Trauma with an Improved Needle Design

2000 ◽  
Vol 11 (7) ◽  
pp. 1325-1330
Author(s):  
EDWARD A. ROSS ◽  
JILL W. VERLANDER ◽  
LILIA C. KOO ◽  
IRVIN F. HAWKINS
Keyword(s):  
Carotid Artery ◽  
Vascular Access ◽  
Neointimal Hyperplasia ◽  
Graft Material ◽  
Dialysis Tubing ◽  
Fresh Tissue ◽  
Synthetic Materials ◽  
Hemodialysis Vascular Access ◽  
Longitudinal Strength ◽  
Repetitive Trauma

Abstract. The maintenance and longevity of hemodialysis vascular access remains one of the most problematic topics in the care of dialysis patients. Although much attention has focused on neointimal hyperplasia, the repetitive trauma to vessel walls by dialysis needles causes significant cumulative damage that has undergone little investigation. Commercial needles have beveled tips with intentional cutting surfaces to ease insertion. It was hypothesized that a pencil-point conical-shaped needle would cause less damage by taking advantage of the elasticity of native fistulae and produce an improved hole configuration in synthetic materials with minimal ability to stretch. A needle was subsequently designed with a removable pencil-point trocar and a side arm for the dialysis tubing. Once the trocar is removed, the blunt-ended cannula can be advanced or can be subject to inadvertent motion without causing damage to the luminal surface of the access. The new design as well as standard 15-gauge hemodialysis needles were tested on Gore-Tex® graft material and two bovine carotid artery preparations. Scanning electron microscopy was used to study the hole patterns. For all materials, the commercial needle holes had typical crescent shapes, and the cuts sliced sequentially through the various layers. For grafts, the new design caused a linear defect parallel to the axis of the graft that may preserve longitudinal strength. Interestingly, that tear line was nearly perpendicular to the linear hole in the thin polytetrafluoroethylene overwrap, which would be consistent with maintenance of hoop integrity. It is believed that these nonoverlapping defects would also improve hemostasis. The bovine specimens tested the importance of tissue stretching : Fresh carotid artery had experimental holes dramatically smaller than those from standard needles. In the denatured tissue, the experimental needle provided less benefit than that observed in fresh tissue, which is likely due to limited elasticity of the preserved artery. Improvement in needle design thus provides distinct advantages for native vessels and unique less traumatic holes in current synthetic materials. Pencil-point needle designs may be particularly applicable to the development of new elastomeric graft material.

scholarly journals Hemodialysis Vascular access maintenance in the Covid-19 pandemic: Positioning paper from the Interventional Nephrology Committee of the Brazilian Society of Nephrology

2020 ◽  
Vol 42 (2 suppl 1) ◽  
pp. 41-43
Author(s):  
Ricardo Portiolli Franco ◽  
Ciro Bruno Silveira Costa ◽  
Clayton Santos Sousa ◽  
Anderson Tavares Rodrigues ◽  
Precil Diego Miranda de Menezes Neves ◽  
...  
Keyword(s):  
Vascular Access ◽  
Healthcare Services ◽  
Arteriovenous Fistulas ◽  
Brazilian Society ◽  
Hemodialysis Vascular Access ◽  
Coronavirus Infection ◽  
Treatment Continuity

ABSTRACT Vascular accesses for hemodialysis are considered the patient’s lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.

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