Vascular access for hemodialysis: from renal hypertension to hemodynamics

Abstract

The creation of the dialysis vascular access has local and systemic hemodynamic effects. Decrease in the local vascular resistance leads to the acceleration of blood flow, which increases the wall shear stress. This ultimately leads to increased production of nitric oxide, dilatation of the feeding artery and increase of blood flow to the limb. High blood flow can cause decompensation of chronic congestive heart failure, less often hyperkinetic heart failure. The most common local complication is ischemia of the limb with the access. The lifespan of native fistulas and accesses with PTFE grafts is limited by the development of stenosis, which leads to the reduction in flow and increases the risk of acute thrombosis and access failure. Regular ultrasonographic screening allows an adequate monitoring of the access flow and quantification of stenoses, which helps to timing of the vascular intervention. The complexity of care is provided by a multidisciplinary team in specialized centers, we make an effort to develop this cooperation on a national level.