Journal article
Cellular and molecular mechanisms underlying hemodialysis arteriovenous fistula dysfunction and approaches to promote maturation: a vascular perspective
American journal of physiology. Heart and circulatory physiology, Vol.329(1), pp.H241-H257
07/01/2025
DOI: 10.1152/ajpheart.00010.2025
PMCID: PMC12237592
PMID: 40465509
Abstract
Hemodialysis requires functional vascular access, which serves as the conduit for blood flow between the patient and the hemodialysis machine. The arteriovenous fistula (AVF), created by surgically connecting an artery to a nearby vein in the upper extremity, is the preferred form of vascular access for maintenance hemodialysis. Newly created AVFs must undergo a maturation process, during which the fistula vein enlarges and develops sufficient lumen size and blood flow to be used effectively for dialysis. However, since the invention of AVFs 60 years ago, rates of AVF maturation failure have remained high. Currently, no proven therapies exist to promote maturation or prevent maturation failure. This review examines the current understanding of the cellular and molecular mechanisms underlying AVF maturation failure, with particular focus on the impact of the chronic kidney disease (CKD) environment on the vascular system. In CKD, patients often have elevated levels of uremic toxins, increased oxidative stress, and chronic inflammation, all of which adversely affect the function of vascular wall cells (such as endothelial cells, vascular smooth muscle cells, and fibroblasts) and circulating cells (such as platelets and immune/inflammatory cells). The goal of this review is to explore the mechanisms influencing both native and AVF vasculature in the context of CKD. In addition, we will discuss current therapies aimed at improving native vasculature in patients with CKD, as well as investigational approaches to promote AVF maturation.
Details
- Title: Subtitle
- Cellular and molecular mechanisms underlying hemodialysis arteriovenous fistula dysfunction and approaches to promote maturation: a vascular perspective
- Creators
- Yan-Ting Shiu - University of UtahHannah Northrup - University of UtahYufeng Huang - University of UtahMonique E. Cho - University of UtahKanokwan Bunsawat - George E. Wahlen Department of VA Medical Center
- Resource Type
- Journal article
- Publication Details
- American journal of physiology. Heart and circulatory physiology, Vol.329(1), pp.H241-H257
- DOI
- 10.1152/ajpheart.00010.2025
- PMID
- 40465509
- PMCID
- PMC12237592
- NLM abbreviation
- Am J Physiol Heart Circ Physiol
- ISSN
- 0363-6135
- eISSN
- 1522-1539
- Publisher
- Amer Physiological Soc
- Number of pages
- 17
- Grant note
- R01DK123727; R01DK129299 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Nora Eccles Treadwell Foundation IK2RX003670; I01BX006269; I01BX006078 / US Department of Veterans Affairs
- Language
- English
- Date published
- 07/01/2025
- Academic Unit
- Health, Sport, and Human Physiology
- Record Identifier
- 9984948045702771
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