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Development of hemodynamic solutions in Renal Dialysis Venous Access Failure

Final Report Summary - REDVA (Development of hemodynamic solutions in Renal Dialysis Venous Access Failure)

Final Report: The ReDVA Project 324487
1st October 2013 – 30th September 2017

The ReDVA project www.redva.eu was targeted at developing successful vascular surgical, medical therapeutic and medical device strategies to improve the performance and longevity of renal dialysis vascular access (VA), which underpins life supporting haemodialysis techniques used in patients with kidney failure. The aims of the ReDVA project were achieved by utilising the expertise from each of the five ReDVA centres, individually and collaboratively. The University of Dundee, examined current and novel pre- and post-surgical VA surveillance imaging techniques, and in collaboration with Guerbet, Paris, they investigated the use of Gadolinium based contrast agents in ‘at risk’ populations within NHS Tayside. To do this effectively, researchers created a novel database containing anonymised scan information from over 28,000 magnetic resonance imaging (MRI) scans. Researchers utilised volunteer MRI images (Fig. 1) to create patient specific flow phantoms (Fig 2), develop flow rig models with pump appropriate output, create computational fluid dynamics (CFD) meshes and establish inlet criteria for CFD simulations. Research studies were published that demonstrated the effectiveness of certain serum biomarkers and surgical and image guided interventions in improving outcomes in vascular access. Novel ultrasound and magnetic resonance imaging protocols were developed by the University of Dundee and validated by fellows at Queen Elizabeth Hospital in Birmingham.
Queen Elizabeth Hospital, Birmingham, also studied novel and established surgical (arteriovenous grafts and arteriovenous fistula) and interventional techniques. They collaborated with Guerbet to collate and compare the strengths and weaknesses of the numerous VA guidelines used worldwide. The University of Limerick, Ireland, in collaboration with Vascular Flow Technologies, Dundee, and the University of Dundee, examined the haemodynamics (blood flow parameters) behind ReDVA, which impact on venous intimal hyperplasia, one of the main causes of vascular access failure.
Researchers from the University of Dundee and Vascular Flow Technologies combined the expertise they gained during the ReDVA project to develop a perfused cadaveric model for VA device testing and VA surgical training and are now actively promoting the model at conferences. They have recently formed a strategic tripartite partnership with NHS Tayside to create a centre of excellence that will build on the clinical and technical expertise developed throughout the ReDVA project. The centre will provide commercial companies, and other research organisations with the knowledge and facilities they require to develop their product from the initial idea stage through to pre-clinical testing and FDA approval. The has gained ReDVA researchers recognition with companies interested in developing new surgical and imaging strategies to improve patient outcomes using flow rigs, computational fluid dynamics and cadaveric modelling. These models have also been optimised for surgical training in new and developing vascular access techniques.
ReDVA fellows worked hard to increase the awareness of issues with renal vascular access in local, regional, national and European settings. They communicated with patients and the public through workshops, newsletters and outreach events. They continue to be closely involved in the European Best Practice Guidelines Review in relation to the vascular access guideline update, and a Cochrane Review title suggestion was accepted. ReDVA’s involvement led to lobbying for national research funding specifically to look at non-invasive imaging effectiveness in NHS patient care. A recent award for such a clinical trial has been made - NIHR 2017.
ReDVA early stage and experienced researchers presented their research at local, national and international conferences: 87 presentations (oral and poster), 6 conference papers, 1 book chapter, 4 plenary sessions and 9 invited lectures. They also published 32 journal publications. The socio-economic impact of potential improvements in patient outcomes in renal access were modelled through new European collaborations (www.vital transformation.com) and reported at scientific meetings.
Due to the nature of the project, all ReDVA researchers were exposed to opportunities, which allowed them to develop valuable multi-disciplinary skills that they would not have developed if they had stayed within their own disciplines. Fourteen of the researcher worked on, or completed their PhD thesis during the project. Eight of the researchers remain with their institutions although the project is finished and all ReDVA centres continue to work together on a number of different projects, with the aim of increasing scientific understanding of vascular access maturation and failure.

Interested parties can contact ReDVA through the Website www.redva.eu