New devices and trials for the treatment and prevention of dialysis access stenosis

Having a healthy kidney is worth a billion dollars. But an unhealthy kidney costs more - about $16 billion more, according to Prabir Roy-Chaudhury, MD, PhD, associate professor in the division of nephrology and hypertension at the University of Cincinnati (UC).

“It costs about $17 billion a year to care for patients with end-stage kidney disease,” he said.

There are currently over 320,000 people undergoing hemodialysis in the United States, a process that costs taxpayers a minimum of $60,000 per patient annually,

Hemodialysis is a technique in which a machine filters wastes out of a patient's blood once the kidney fails.

“In order to perform successful dialysis, it's critical to have a functioning vascular access,” Roy-Chaudhury said.

There are two main types of permanent dialysis access: an arteriovenous fistula, which connects the artery and the vein directly, and an arteriovenous graft, which connects the artery and the vein using a plastic tube.

Unfortunately, these connections may only last between six and 12 months due to stenosis, or narrowing of the veins.

As a result, hemodialysis patients often have repeated hospital admissions and surgeries in order to keep their dialysis access open.

In fact, problems associated with vascular access are probably the biggest factors that reduce the quality of life for hemodialysis patients, Roy-Chaudhury said.

“Hemodialysis vascular access dysfunction is viewed as the Achilles heel of dialysis,” he added.

In order to reduce the problems linked with hemodialysis vascular-access dysfunction, Roy-Chaudhury, UC surgeons Rino Munda, MD, and Steve Woodle, MD, and colleagues in engineering, radiology, cardiology and pathology have established the Cincinnati Dialysis Access Research Program (CAP).

CAP is a multidisciplinary program that includes NIH-funded basic science research, industry- funded animal studies of new devices and clinical trials for the treatment and prevention of dialysis access stenosis.

Some of the clinical trials being conducted by UC's division of nephrology and transplant surgery include the use of medicated wraps, placed around the access area at the time of surgery. Others include special balloons that allow physicians to deliver a drug directly to the outside of the vessel wall following expansion of the vessel.

“The mission of the CAP is to improve the quality of life for dialysis patients by reducing the problems associated with dialysis vascular access,” said Roy-Chaudhury. “We also believe that we can save taxpayers money through our application of cutting-edge technology.”

“The fact that we have different specialists working on the same project is a huge strength and a credit to the research atmosphere at UC.”