New study identifies better treatment option for common complication of dialysis

August 19, 2020

A Mount Sinai-led study has identified a better treatment option for a common complication of hemodialysis, bringing new hope to millions of patients who rely on dialysis to survive but often must undergo repeated hospital visits to make continued treatment possible.

The study, published today in the New England Journal of Medicine, used drug-coated balloon angioplasty to treat arteriovenous fistulas, access points created by surgeons through which the patient's blood can be removed, sent through the dialysis machine to have impurities filtered out, and returned to the patient's body. Hemodialysis fistulas frequently become blocked and stop working. This has traditionally been treated by either inserting a stent to keep the fistula open, or by standard angioplasty, in which a tiny balloon is threaded through the blood vessel and then expanded to force the fistula open. Both procedures are commonly used, but in many cases, they only are able to keep the vessel open for a few months.

"Patients with this debilitating disease frequently require multiple visits to the hospital for treatment and face a life-long battle to maintain their access point used for dialysis," said Robert A. Lookstein, MD, MHCDL, Professor of Radiology, and Surgery, at the Icahn School of Medicine at Mount Sinai and Executive Vice Chair of Diagnostic, Molecular, and Interventional Radiology at Mount Sinai Health System, who led the international team of investigators. "The access points often become blocked or damaged and unable to be used, requiring multiple procedures or interventions to restore the function of the access."

Nearly 2.5 million patients worldwide regularly undergo hemodialysis, according to the European Renal Care Provider Association.

In this prospective, randomized trial (IN.PACT AV, Medtronic access study), 170 subjects were assigned to receive treatment with a drug-coated balloon and 160 were assigned to receive treatment with a standard balloon. Patients who received the drug-coated balloon were 25 percent more likely to still have a functioning access point after 6 months, compared to those receiving the standard balloon treatment. In addition, the number of procedures required to maintain the opening was decreased by over 50 percent for those who received the drug coated balloon.

"This treatment has the potential to offer patients with end-stage renal disease continuous hemodialysis, avoiding unnecessary procedures and surgeries which can dramatically affect patients over the course of their lives. This is a game changer for patients who are often tethered to a health care facility for treatment and maintenance of a poorly functioning dialysis access. If we can reduce the number of interventions and keep these patients out of the hospital, we can dramatically improve their quality of life," said Dr. Lookstein.
This research was supported by Medtronic.

The Mount Sinai Hospital / Mount Sinai School of Medicine

Related Dialysis Articles from Brightsurf:

Immediate dialysis no better than wait-until-necessary approach, researchers find
In the largest international study of its kind, researchers at the University of Alberta and Toronto's St.

Predictors of 5-year mortality in young dialysis patients
The analysis published in NDT [1] evaluated for the first time the association of a large number of demographic, HD treatment and laboratory variables with mortality in patients on chronic hemodialysis treatment since childhood.

COVID-19 mortality alarmingly high in dialysis patients
Analysis of a Spanish experience shows that COVID-19 is frequent in hemodialysis patients, who appear to be at risk for worse outcome.

Survival following switch from urgent in-center hemodialysis to home dialysis
Few patients who start urgent and unplanned dialysis in clinical centers switch to home dialysis.

Is ownership of dialysis facilities associated with access to kidney transplants?
An analysis that included data for nearly 1.5 million patients with end-stage kidney disease looked at whether ownership of dialysis facilities was associated with patients' access to kidney transplants.

At-home dialysis improves quality of life
The rate of people starting voluntary at-home peritoneal dialysis rose from 15% to 34% over 10 years at Kaiser Permanente in Northern California, providing a convenient and safe way to manage advanced-stage kidney disease compared with center-based hemodialysis, according to research published today in JAMA Internal Medicine.

Hydration sensor could improve dialysis
Researchers from MIT and Massachusetts General Hospital have now developed a portable sensor that can accurately measure patients' hydration levels using a technique known as nuclear magnetic resonance (NMR) relaxometry.

Uncovering possible role of polyphosphate in dialysis-related amyloidosis
Researchers from Osaka University found that the low concentrations of the naturally occurring biopolymer, polyphosphate (polyP), induces amyloid formation from β2 microglobulin under both acidic and neutral conditions but by different mechanisms.

Study compares dialysis reimbursement around the globe
Dialysis reimbursement policies in most countries are focused on conventional in-center hemodialysis, although home hemodialysis and peritoneal dialysis might contribute to quality of life and cost savings.

Elderly patients on dialysis have a high risk of dementia
Older kidney disease patients who are sick enough to require the blood-filtering treatment known as dialysis are at high risk of dementia, including Alzheimer's disease, according to a study led by scientists at Johns Hopkins Bloomberg School of Public Health.

Read More: Dialysis News and Dialysis Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to