At Brigham and Women’s Hospital, dialysis patients who require simple or complex access repair or revisions are treated by members of the interdisciplinary Interventional Nephrology Program, one of few programs of its kind across the country.
“We are focused on finding new solutions for very difficult medical situations, with dialysis access for patients on hemodialysis as well as peritoneal dialysis,” said Dirk M. Hentschel, MD, Director of Interventional Nephrology.
The team employs a repertoire of percutaneous interventions for treating fistula or graft stenosis, thrombosis, and other complications that could interrupt or delay dialysis. “We often deal with central vein occlusion. We can recanalize large central veins and then we stent or stent-graft them,” Dr. Hentschel said.
The Interventional Nephrology Program serves patients from more than 45 dialysis units throughout New England. Dr. Hentschel said that roughly 30 percent of the procedures performed under the Program are urgent or emergent interventions.
“None of what we do happens in isolation,” explained Dr. Hentschel. “We are in the very fortunate situation to work in close collaboration with vascular surgeons and transplant surgeons who create the access.”
Interventional nephrologists and surgeons have a twice-monthly clinic, in which specialists jointly meet with patients, allowing for timely discussions of optimal treatment approaches to address each patient’s unique medical problem.
In addition to performing critical interventional procedures, nephrologists and surgeons are continually exploring methods for improving dialysis through better access and safer delivery of renal filtration services.
For example, Dr. Hentschel and colleagues are recruiting patients for the HUMANITY trial (“An Assessment of Humacyte’s Human Acellular Vessel in Patients Needing Renal Replacement Therapy: A Comparison With ePTFE Grafts as Conduits for Hemodialysis”; NCT02644941).
The trial will be comparing an experimental human acellular vessel (HAV) with an expanded polytetrafluoroethylene artificial vessel for use in hemodialysis access grafts. The tissue-engineered HAV are “off-the-shelf” grafts formed in a proprietary bioreactor from banked human vascular smooth muscle cells. The engineered grafts are then decellularized to remove cells and DNA, leaving a vascular scaffold containing extracellular matrix proteins that preserve the mechanical properties of the vessel.
They are also involved in another two large clinical trials, PATENCY-1 (NCT02110901) and PATENCY-2 (“A Study of Vonapanitase [PRT-201] Administered Immediately after Radiocephalic Arteriovenous Fistula Creation in Patients With Chronic Kidney Disease;” NCT02414841) of the experimental agent vonapanitase for maintaining patency of radiocephalic arteriovenous fistulae created for hemodialysis. (Contact Dr. Hentschel at (617) 983-4888 for information about enrolling patients in HUMANITY and PATENCY-2.)
To refer a patient, or for more information, please contact our Referral Coordinators at (617) 732-9894.
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