Reducing blockage fails to improve access to the bloodstream for kidney dialysis

May 22, 2008

Reducing early blockages in bloodstream access for kidney failure treatment does not increase the likelihood that the access will function adequately for long-term treatments, according to a study funded by the National Institutes of Health. Results were published May 14, 2008, in the Journal of the American Medical Association.

"Since most of the 470,000 Americans with kidney failure depend on hemodialysis for survival, there is a clear and compelling need to evaluate therapies that reduce or prevent access failure," said NIH Director Elias A. Zerhouni, M.D. "These results tell us we need to keep looking for solutions."

Hemodialysis filters waste and extra fluid from the bloodstream and requires a vascular access — a site on the body where blood is removed and returned. Fistulas are the preferred type of access since they clot less often, experience fewer infections, and are less costly; patients with fistulas also have lower mortality.

A fistula is created by joining a section of an artery and a vein to make one large vessel capable of handling high volumes of blood during hemodialysis. But maintaining any access site is a major clinical challenge. Blood clotting in the fistula is the most frequent cause of early fistula failure. Clotting, infection and low blood-flow rates in the access site are common reasons for hospitalizations requiring multiple treatments or surgeries. Read about vascular access at kidney.niddk.nih.gov/kudisease… /pubs/vascularaccess.

The Dialysis Access Consortium (DAC) found that only 12 percent of patients developed blood clots in the fistula when treated with the clot-preventing drug clopidogrel, compared to nearly 20 percent of patients treated with placebo. Nevertheless, about 60 percent of new fistulas in each group could not be used for long-term dialysis treatments. Complications such as bleeding were similar across the study groups.

DAC studied nearly 900 patients at 9 U.S. medical centers in academic and community practices in urban and rural settings. Participants received a new fistula and took the anti-platelet drug clopidogrel (Plavix) or a placebo tablet daily for 6 weeks to determine if the drug would maintain blood flow in fistulas and increase the number suitable for dialysis.

"Because vascular access is critical for delivering lifesaving care, we are already organizing another multi-center study to look for other ways to improve fistulas," said co-author Catherine M. Meyers, M.D., a kidney specialist in charge of DAC at NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which funded the study.

Source: NIH

Explore further: Growing a blood vessel in a week

add to favorites email to friend print save as pdf

Related Stories

Travel may be hazardous to dialysis patients

Oct 30, 2009

If you're sick, traveling to a foreign land may boost your spirits, but jeopardize your health, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in ...

Recommended for you

Growing a blood vessel in a week

Oct 24, 2014

The technology for creating new tissues from stem cells has taken a giant leap forward. Three tablespoons of blood are all that is needed to grow a brand new blood vessel in just seven days. This is shown ...

Testing time for stem cells

Oct 24, 2014

DefiniGEN is one of the first commercial opportunities to arise from Cambridge's expertise in stem cell research. Here, we look at some of the fundamental research that enables it to supply liver and pancreatic ...

Team finds key signaling pathway in cause of preeclampsia

Oct 23, 2014

A team of researchers led by a Wayne State University School of Medicine associate professor of obstetrics and gynecology has published findings that provide novel insight into the cause of preeclampsia, the leading cause ...

Rapid test to diagnose severe sepsis

Oct 23, 2014

A new test, developed by University of British Columbia researchers, could help physicians predict within an hour if a patient will develop severe sepsis so they can begin treatment immediately.

User comments : 0