Blood Purification

Molecular Insights and Novel Approaches toward Individualized Arteriovenous Fistula Care

Xin Wang, Leticia M Tapia Silva, null, null, null, Nadja Grobe


The aim of the paper is to summarize the current understanding of the molecular biology of arteriovenous fistula (AVF). It intends to encourage vascular access teams, care providers, and scientists, to explore new molecular tools for assessing the suitability of patients for AVF as vascular access for maintenance hemodialysis (HD). This review also highlights most recent discoveries and may serve as a guide to explore biomarkers and technologies for the assessment of kidney disease patients choosing to start kidney replacement therapy. Objective criteria for AVF eligibility are lacking partly because the underlying physiology of AVF maturation is poorly understood. Several molecular processes during a life cycle of an AVF, even before creation, can be characterized by measuring molecular fingerprints using newest "omics" technologies. In addition to hypothesis-driven strategies, untargeted approaches have the potential to reveal the interplay of hundreds of metabolites, transcripts, proteins, and genes underlying cardiovascular adaptation and vascular access-related adjustments at any given timepoint of a patient with kidney disease. As a result, regular monitoring of modifiable, molecular risk factors together with clinical assessment could help to reduce AVF failure rates, increase patency, and improve long-term outcomes. For the future, identification of vulnerable patients based on the assessment of biological markers of AVF maturation at different stages of the life cycle may aid in individualizing vascular access recommendations.

About the Author

Xin Wang, PhD

Senior Research Scientist

Xin joined RRI as senior research scientist in August 2020. He holds a PhD in genetics and a master's degree in computer science. He brings to the laboratory team at RRI a diverse set of skills including expertise in molecular biology, genetics, genomics, and bioinformatics. Prior to joining RRI, he had worked for more than ten years at Memorial Sloan Kettering Cancer Center, where he conducted research to study mechanisms of gene regulation and roles of aberrant gene regulation in cancer using a combination of molecular biological, biochemical, and computational approaches.

Nadja Grobe, MS, PhD

Manager of Laboratory Research

Nadja received her MS and PhD in biochemistry from the Martin Luther University Halle-Wittenberg, Germany. Prior to joining RRI in 2017, she gained more than 10 years of experience in guiding and implementing chemistry, biochemistry, and biomedical-focused research teams in nonprofit, academia, and government. Her previous research has been funded by the American Heart Association, the National Institutes of Health, and the American Society of Nephrology.

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