Kidney Week 2025 Annual Meeting-Dialysis Vascular Access: From Basic Discovery to Translational Science

Video Transcription

Video Summary

This recorded ASN oral abstract session on dialysis vascular access highlighted new basic-to-translational research on arteriovenous fistula (AVF) failure, human remodeling biology, and emerging technologies.<br /><br />A mouse AVF single-cell/temporal transcriptomic atlas showed remodeling occurs in waves: early inflammation followed by extracellular matrix (ECM) deposition. Profibrotic macrophages signal to activated fibroblasts via TGF-β/SMAD pathways, inducing lysyl oxidase (LOX). Conditional LOX deletion improved vascular remodeling (larger lumen/wall area), suggesting selective LOX targeting could reduce fibrotic failure while avoiding aneurysm risk.<br /><br />A second mouse study used smooth muscle–specific IRS1 knockdown. Loss of IRS1 (linked to p53–KLF4–mediated smooth muscle differentiation) produced severe juxta-anastomotic stenosis and thrombosis, positioning IRS1 deficiency as a model for AVF dysfunction and a potential therapeutic axis.<br /><br />Human cohorts from Taiwan examined β-catenin, Notch, and TGF-β signaling in AVF maturation. Higher collagen content pre- and post-operatively correlated with non-maturation. Notch activation associated with reduced medial smooth muscle and medial area, while TGF-β signaling was suppressed in non-maturing AVFs.<br /><br />University of Florida investigators performed single-cell RNA-seq on paired “pre-access” basilic veins and post-creation fistula veins from two-stage surgeries. Fistulas showed fewer smooth muscle cells and more macrophage/monocyte and angiogenic endothelial subsets, with widespread ECM remodeling signatures and cell-type–specific inflammatory patterns.<br /><br />Epidemiologic USRDS analysis (2013–2022) found AVF use at dialysis initiation declined (17% to 12%) while catheter starts rose (>70%), worsening during COVID-19 and disproportionately affecting Black, Native American, younger adults, and dual-eligible patients.<br /><br />Technologies included an AI-guided robotic tomographic ultrasound mapping system with high scan completion and rapid reporting, and two-year randomized trial results showing an acellular tissue-engineered vessel improved early patency and usability—especially in high-risk patients—though with more stenosis/thrombosis requiring interventions. A swine single-cell AVF study emphasized vein fibrosis/ECM differences and suggested arteries become more “vein-like” over time, refining translational targeting.

Asset Subtitle

Moderator(s): Dirk Hentschel, Timmy Lee

Presentation(s):

Arteriovenous Fistula Under LOXdown: Halting Fibrotic Remodeling to Prevent Failure - Filipe Stoyell-Conti
IRS-1/KLF-4-Mediated Vascular Smooth Muscle Cells Differentiation Is Critical for Arteriovenous Fistula Maturation in a Mouse Model - Gang Xi
JNK-Associated Leucine Zipper Protein Protects Intimal Hyperplasia and Mitigates Arteriovenous Fistula (AVF) Dysfunction by Regulating the TGF-β1/Smad Signaling Pathway - Qunpeng He
Vascular Remodeling in Human Arteriovenous Fistula Maturation: Roles of β-Catenin, Notch, and Transforming Growth Factor (TGF)-β Signaling Pathways - Chung-te Liu
Single-Cell Transcriptomics Analysis of Preaccess and Arteriovenous Fistula Veins - Yong He
A Decade in Decline: United States Renal Data System Analysis of Vascular Access Trends at Hemodialysis Initiation by Gender, Race, Age, and Insurance - Ohm Tripathi
Robotic Artificial Intelligence (AI)-Guided Tomographic Ultrasonography: Breakthrough in Haemodialysis Access Planning - Varshasb Broumand
Two-Year Outcomes from a Prospective Randomized Trial of Humacyte's Acellular Tissue Engineered Vessel vs. Autologous Arteriovenous Fistula for Hemodialysis Access - Mohamad Hussain
Transcriptional Dynamics in the Swine Arteriovenous Fistula: Bridging Translational Research and Molecular Biology - Laisel Martinez

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/8/2025

Pathway 1 Dialysis

Session ID 519846

Keywords

dialysis vascular access

arteriovenous fistula failure

single-cell transcriptomic atlas

extracellular matrix remodeling

TGF-beta SMAD signaling

lysyl oxidase LOX targeting

profibrotic macrophages

smooth muscle IRS1 knockdown

juxta-anastomotic stenosis thrombosis

beta-catenin Notch signaling

AVF maturation non-maturation collagen

USRDS trends catheter starts COVID-19 disparities

tissue-engineered acellular vascular graft patency