Understanding the pathophysiology of hemodialysis access problems as a prelude to developing innovative therapies

Maintenance of a functioning vascular access for hemodialysis is a major challenge. This Review summarizes recent insights into the pathophysiology of the major complications of vascular accesses—thrombosis, stenosis, aneurysms, fistula maturation failure and catheter infection—and outlines innovative ideas for the prevention and treatment of these complications that have emerged as a result of our improved understanding. These ideas include interfering with bacterial quorum sensing, blocking growth factors that are involved in intimal hyperplasia, and inhibiting matrix metalloproteinases.