IMPROVED SURGICAL MANAGEMENT STRATEGIES FOR RENAL REPLACEMENT THERAPIES IN END-STAGE KIDNEY DISEASE

Abstract

End-stage renal disease (ESRD) represents a serious public health problem, requiring renal replacement therapies (RTR) such as hemodialysis, peritoneal dialysis and kidney transplantation. The long-term success of these therapies depends on several factors, including appropriate surgical management of vascular accessions. Vascular accessions are essential for vascular access during dialysis and kidney transplant procedures, and the choice of access type, surgical techniques and post-operative care are crucial to ensure their patency and durability. The evolution of surgical techniques and the development of new materials have provided significant advances in the management of vascular accessions, aiming to minimize complications and optimize the quality of life of patients with ESRD. Objective: The objective of this systematic literature review was to identify and analyze the most recent and effective surgical strategies for the management of vascular accessions in patients with ESRD, with a focus on improving patency, durability and quality of life. Methodology: A systematic review of the literature was carried out, following the recommendations of the PRISMA statement, in the PubMed, Scielo and Web of Science databases. The search was carried out using the following descriptors: "chronic kidney disease", "renal replacement therapy", "vascular access", "vascular surgery" and "complications". Original articles published in the last 10 years were included, which addressed studies on adult humans undergoing surgical procedures to create or maintain vascular access for RRT. Animal studies, systematic reviews, meta-analyses and articles that did not address the central theme of the review were excluded. Results: The review identified a set of studies that addressed different aspects of the surgical management of vascular accesses, including the choice of access type, surgical techniques, the use of new materials and the impact on complication rates and access survival. The results highlighted the importance of individualizing treatment, considering the characteristics of each patient and the type of RRT. The use of new surgical techniques, such as the creation of arteriovenous fistulas with end-to-side anastomoses and the use of biocompatible materials, has shown promise in terms of reducing thrombosis and stenosis rates. Furthermore, intensive postoperative care, with regular monitoring of access patency and early treatment of complications, is essential to ensure the durability of vascular accesses. Conclusion: Surgical management of vascular accessions in patients with ESRD is a fundamental aspect for the success of renal replacement therapies. The evolution of surgical techniques and the development of new materials have provided significant advances in this field, allowing the creation of longer-lasting vascular accesses with a lower rate of complications. Individualization of treatment, appropriate choice of access type and intensive postoperative care are essential to guarantee the quality of life of patients with ESRD. However, more research is needed to evaluate the long-term effectiveness of new surgical techniques and identify new biomarkers that can predict the success of vascular accessions.