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Disruptive technological advances in vascular access for dialysis: an overview

Pediatric Nephrology volume 33, pages 2221–2226 (2018)Cite this article

Abstract

End-stage kidney disease (ESKD), one of the most prevalent diseases in the world and with increasing incidence, is associated with significant morbidity and mortality. Current available modes of renal replacement therapy (RRT) include dialysis and renal transplantation. Though renal transplantation is the preferred and ideal mode of RRT, this modality may not be available to all patients with ESKD. Moreover, renal transplant recipients are constantly at risk of complications associated with immunosuppression and immunosuppressant use, and posttransplant lymphoproliferative disorder. Dialysis may be the only available modality in certain patients. However, dialysis has its limitations, which include issues associated with lack of vascular access, risks of infections and vascular thrombosis, decreased quality of life, and absence of biosynthetic functions of the kidney. In particular, the creation and maintenance of hemodialysis vascular access in children poses a unique set of challenges to the pediatric nephrologist owing to the smaller vessel diameters and vascular hyperreactivity compared with adult patients. Vascular access issues continue to be one of the major limiting factors prohibiting the delivery of adequate dialysis in ESKD patients and is the Achilles’ heel of hemodialysis. This review aims to provide a critical overview of disruptive technological advances and innovations for vascular access. Novel strategies in preventing neointimal hyperplasia, novel bioengineered products, grafts and devices for vascular access will be discussed. The potential impact of these solutions on improving the morbidity encountered by dialysis patients will also be examined.

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Affiliations

  1. Shaw-National Kidney Foundation-National University Hospital Children’s Kidney Centre, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore

    Wee-Song Yeo

  2. Division of Pediatric Nephrology, Dialysis and Renal Transplantation, Department of Pediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Wee-Song Yeo

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Qin Xiang Ng

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Yeo, WS., Ng, Q.X. Disruptive technological advances in vascular access for dialysis: an overview. Pediatr Nephrol 33, 2221–2226 (2018). https://doi.org/10.1007/s00467-017-3853-7

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Keywords

  • End-stage kidney disease
  • Dialysis
  • Disruptive technological advances and innovations