Pharmacological approaches to preventing vascular access failure

The establishment and maintenance of vascular access in haemodialysis patients represent a major cause of morbidity in nephrology units. The native arteriovenous fistula (AVF) is the vascular access of first choice for haemodialysis with superior long-term patency, lower costs and infection rates compared to arteriovenous grafts and central venous catheters. However, primary failure (failure of the created AVF to be suitable for dialysis) in AVF is a major problem. While rates of primary failure are lower for AVG, this access has unacceptably high overall thrombosis rates compared to AVF. The objective of this guideline is to review the evidence for pharmacological interventions aimed at reducing thrombosis of vascular access for haemodialysis.