Dialysis Access Dysfunction

Copyright © 2012 Alexander Yevzlin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Vascular access failure (VAF) is the most common reason for hospitalization among hemodialysis (HD) patients. The economic burden of VAF is estimated to be greater than 1 billion dollars per year and continues to grow. The purpose of this special issue is to focus on recent advances in our understanding of dialysis access dysfunction. Thanks in part to several national initiatives, the rate of arteriovenous fistula (AVF) placement continues to rise in the United States. AVF failure remains a major concern. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of of surveillance studies, as to whether early surveillance actually improves the longevity of an access system. Evaluating the available information for surveillance, specifically the data for AVF stenosis and survival, is necessary to determine if surveillance is of any benefit. In an attempt to clarify ambiguities, one of the articles in this issue attempts to review the question: Does regular surveillance improve the long-term survival of arteriovenous fistulas? Similarly, L. Kumbar et al., have contributed to this special issue with an evaluation of access surveillance outcomes. They state that although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have evaluated the role of different surveillance techniques. The authors conclude that the limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multi-centered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistulas and grafts. Another important contribution is made by M. L. Zadeh et al. in this special issue. The authors observe that while native AVF is the recommended vascular access for HD, its failure to mature remains a major problem. The aim of their study was to determine the correlation between diameter and maturation of vessels in radiocephalic AVF. The authors performed a prospective cross-sectional study carried out during 2006-2007 on 96 hemodialysis patients from Hashem-inejad Kidney Center. The maturation of fistula showed correlation …