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Materials Used for Hemodialysis Vascular Access: Current Strategies and a Call to Action

Axel Haverich, MD

Hannover Medical School

Renal replacement programs are an integral therapeutic part of end-stage renal disease. However, the increasing lack of donor organs, associated with an increasing number of patients requiring permanent hemodialysis necessitates the implantation of a hemodialysis access. However, natural vessels are often not or no longer usable after long-standing dialysis. Therefore, arteriovenous grafts, that is, polytetraflouroethylene (PTFE) grafts, are used at increasing frequency. However, PTFE grafts especially are associated with two untoward consequences: high rates of arteriovenous access thrombosis and infection. In this review, current strategies are discussed and requirements for future graft materials are defined. Biological implants show relative resistance to infection and rejection. Therefore, biological implants seem to provide the most useful tool in managing complications associated with hemodialysis vascular access. Thus, it is time to develop new strategies and new graft materials that fulfill the "physiological" requirements of an optimal vascular access to prolong patient survival on dialysis, reducing morbidity and escalating costs.

Key Words: hemodialysis • vascular access • dialysis • shunt • arteriovenous • renal end-stage disease

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