Status of research in vascular access for dialysis

Abstract

Vascular access issues impose a major financial burden to health care and can be associated with increased morbidity and mortality. In this context, strategies, guidelines and available published information become important tools for health-care facilities and workers. While published data form a sound basis of formulating clinical practice guidelines for vascular access (VA), quality of the medical information is critically important. This study investigates the current status of VA publications. A PubMed search was performed to capture all articles related to dialysis vascular access published from January 1997 to December 2009. The articles were categorized by publication type, study subject, year of publication and specialty of the authors. A total of 2260 articles from 60 medical journals were identified. Insignificant publications (letters/communications, n = 125) were excluded from the analysis. Therefore, 2135 articles formed the basis for analysis. Sixteen of the 60 journals routinely published on vascular access and generated 1747 articles [nephrology = 7 (publications = 782); radiology = 4 (publications = 333); surgery = 5 (publications = 486)], while 44/60 journals published scarcely and produced 388 articles over the 13-year period. Overall, 1213 (57%) of the articles were published by the direct involvement of nephrologists [nephrologists alone (n = 564); nephrologists in collaboration with others (n = 649)]. There were 1194 observational studies, 444 case reports/series, 375 review/editorials, 51 basic research, 12 meta-analyses and 59 randomized controlled trials published over the 13-year period. The average impact factor for nephrology, radiology and surgery journals that routinely published on vascular access was 4.425, 3.099 and 2.679, respectively. Despite an increased rate of scholarly activity in the area of vascular access, there remains a significant challenge ahead due to the lack of randomized controlled trials and research focusing on the biology of vascular access stenosis.