Yale School of Medicine Professor of Surgery (Vascular), Alan Dardik, MD, PhD, has received an NIH Research Project Grant (R01) for his proposal, “Adaptive immunity regulates arteriovenous fistula remodeling.” The project aims to address an existing knowledge gap in the biology of venous remodeling, that, if better understood, could lead to significant improvements in successful treatment options for patients requiring hemodialysis.
Of more than 786,000 Americans live with end-stage renal disease, 550,000 require dialysis, according to the NIH National Institute of Diabetes and Digestive and Kidney Diseases. The standard method for dialysis treatment involves the surgical creation of an arteriovenous fistula (AVF), which thereby serves as a conduit to filter waste from the blood when kidneys are damaged or fail. While the method has remained the standard for the past 50 years, the technique has its shortcomings, often requiring re-do procedures and surgery, especially in women.
Sixty percent of fistulas fail to mature, and only 50% are still usable a year later. For women, success rates are even lower, with just 40% of fistulas still usable at one year. "Eventually these patients can only receive dialysis with a catheter, which carries a significant increased risk of infection and mortality," said Dr. Dardik.
Understanding the molecular mechanisms by which AVF conduits successfully adapt — or not — has been the crux of Dr. Dardik’s research for the past decade. The lab’s latest research uses an in-vivo model to explore the role of adaptive immunity in the regulation of venous remodeling in men versus women.
“Given the significant need for dialysis, we are particularly interested in developing innovative models and tools that can improve AVF patency. This investigation could have lasting impact by establishing a new and valuable strategy for clinical translation,” said Dr. Dardik.
Yale researchers Tarek Fahmy, Daniel Jane-Wit, and Jordan Pober contributed to the research.