FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Em meio Ãs doenÃas crÃnicas existentes està a InsuficiÃncia Renal CrÃnica (IRC), caracterizada como uma patologia de instalaÃÃo gradual, na qual o indivÃduo acometido desenvolve dependÃncia de uma terapÃutica contÃnua, a diÃlise. Esse fato causa modificaÃÃes no estilo de vida e pode repercutir na saÃde mental e qualidade de vida. O impacto causado por uma doenÃa e seu tratamento à diferente de um indivÃduo para outro, sendo necessÃrios estudos que valorizem os aspectos integrais do ser humano, de modo a se tornar subsÃdio para direcionar as aÃÃes profissionais, especialmente, as da equipe de enfermagem. Apesar das diversas inovaÃÃes tecnolÃgicas incorporadas no cuidado à pessoa com insuficiÃncia renal crÃnica em tratamento hemodialÃtico percebemos que nÃo existe um olhar diferenciado para a promoÃÃo da saÃde mental desses sujeitos e pouca Ãnfase à dada ao uso da tecnologia leve neste contexto, principalmente, quando a clientela pesquisada à o adolescente. Este estudo teve como objetivo avaliar o uso da tecnologia leve na promoÃÃo da saÃde mental e da qualidade de vida de adolescentes renais crÃnicos. Trata-se de uma investigaÃÃo convergente-assistencial realizada em uma clÃnica de diÃlise, referÃncia no atendimento de adolescentes com IRC, localizada em Fortaleza/CearÃ, no perÃodo de dezembro de 2011 a abril de 2012. Participaram oito adolescentes com diagnÃstico de IRC submetidos à hemodiÃlise. O projeto foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. A produÃÃo de dados foi realizada em duas fases (prà e pÃs desenvolvimento das oficinas vivenciais), compreendendo a aplicaÃÃo do questionÃrio sobre qualidade de vida (QV), entrevista semiestruturada e observaÃÃo estruturada. Os dados sobre QV foram coletados por meio de um questionÃrio WHOQOL Bref, constituÃdo de 26 perguntas que abrangem quatro domÃnios: fÃsico, psicolÃgico, relaÃÃes sociais e meio ambiente. Para realizar a anÃlise das informaÃÃes coletadas utilizamos um processo de estruturaÃÃo de Morse e Field, apresentado por Trentini e Paim. Os dados coletados por meio do WHOQOL Bref foram analisados conforme modelo estatÃstico (SPSS- Statistical Package for the Social Sciences - versÃo 15.0). Com base nos dados produzidos antes da realizaÃÃo das oficinas, emergiram quatro categorias de anÃlise: contextualizando a dinÃmica de tratamento dos adolescentes em hemodiÃlise; conhecendo os adolescentes em hemodiÃlise e a sua relaÃÃo com o adoecimento; significado da vivencia do adolescente renal crÃnico em hemodiÃlise; expectativas dos adolescentes quanto à participaÃÃo nas oficinas. Em seguida desenvolvemos as oficinas vivenciais, utilizando a tecnologia leve no cuidado de enfermagem e, posteriormente, a avaliaÃÃo da estratÃgia na percepÃÃo do adolescente. Nesta etapa foram desveladas trÃs categorias: consideraÃÃes dos adolescentes em relaÃÃo Ãs oficinas; repercussÃes na condiÃÃo vivenciada e significados dos encontros. Com base nos resultados, consideramos que a utilizaÃÃo da tecnologia leve como cuidado de enfermagem favoreceu a promoÃÃo da saÃde mental e da qualidade de vida dos adolescentes em tratamento hemodialÃtico, constituindo-se em um importante instrumental na assistÃncia desta clientela. / Amid existing chronic diseases are chronic renal failure (CRF), a disease characterized as gradual installation, in which the affected individual develops dependence on continuous therapy, dialysis. This fact leads to changes in lifestyle and can affect the mental health and quality of life. The impact of a disease and its treatment is different from one individual to another, and studies that value the integral aspects of being human, so as to make allowance for directing the actions professionals, especially the nursing staff. Despite various technological innovations incorporated in care for people with chronic renal failure on hemodialysis realize that there is a different look for the promotion of mental health of these individuals and little emphasis is given to the use of light technology in this context, especially when the clientele researched is the teenager. This study aimed to evaluate the use of soft technology in promoting mental health and quality of life of adolescents with chronic renal failure. This is a convergent-care research conducted in a dialysis clinic, reference in adolescents with IRC, located in Fortaleza / CearÃ, from December 2011 to April 2012. Participants were eight adolescents diagnosed with CRF undergoing hemodialysis. it is emphasized that the project was approved by the Ethics Committee of the Universidade Federal do CearÃ. The production data was divided into two phases (pre-and post-development workshops), subdivided in the questionnaire on quality of life (QOL), a semistructured interview and structured observation. The QOL data were collected through a questionnaire WHOQOL Bref, consisting of 26 questions covering four domains: physical, psychological, social relationships and environment. To perform the analysis of the information collected used a process of structuring Morse and Field, presented by Trentini and Paim. The data collected through the WHOQOL Bref were analyzed according to the statistical model (SPSS-Statistical Package for the Social Sciences - version 15.0). Four categories emerged from analysis of prior experiential workshops - contextualizing the dynamic treatment of adolescents on hemodialysis; knowing adolescents on hemodialysis and its relationship with the illness; meaning of the experiences of adolescents with chronic kidney disease on hemodialysis and expectations of adolescents regarding the participation in workshops . Then we develop experiential workshops, using light technology in nursing care and subsequently, evaluation of strategy on the perception of the adolescent. In this step was unveiled three categories: considerations of adolescents concerning the workshops; repercussions on condition experienced and meanings of the meetings. Based on the results, it is considered that the use of technology as a lightweight nursing care favored the promotion of mental health and quality of life of adolescents on hemodialysis, thus becoming an important instrumental in assisting this clientele.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-14T19:52:57Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação do pH CT e FS de pac port insuf renal crônica PDF.pdf: 1534121 bytes, checksum: 8bf3ad1a647393c4291e183c75402b3e (MD5) / Made available in DSpace on 2016-07-14T19:52:57Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação do pH CT e FS de pac port insuf renal crônica PDF.pdf: 1534121 bytes, checksum: 8bf3ad1a647393c4291e183c75402b3e (MD5) Previous issue date: 2011-08-18 / O objetivo do presente trabalho foi avaliar o pH, capacidade tampão e fluxo salivar em pacientes com insuficiência renal crônica, antes e após a hemodiálise. Metodologia: estudo transversal, com 55 pacientes assim distribuídos: amostra de conveniência, composta de 32 indivíduos (18 homens, média de idade 59,5 anos, com idade variando de 28 a 87 anos e 14 mulheres, média de idade 48,2 anos, com idade variando de 30 a 83 anos) que se submetiam constantemente ao procedimento de hemodiálise em clínica particular na cidade de Maceió- AL (grupo 1) e 23 indivíduos (12 homens e 11 mulheres com média de idade de 24 e 22 anos respectivamente, com variação de 21 à 29 anos), composto por alunos do curso de odontologia do Centro universitário Cesmac e da Universidade Federal de Alagoas (grupo 2, controle). O fluxo salivar foi medido com seringa descartável de 5 mL. Para análise do pH foi utilizado pHmetro, a capacidade tampão foi avaliada através da diluição da saliva (2mL) em acido cítrico à 2% (2mL). A análise estatística foi realizada através dos testes de ANOVA, Tukey, Kruskal-Wallis e Dunn. Resultados: A hemodiálise não alterou as características do pH, fluxo e capacidade tampão da saliva. Comparando o grupo1 e o grupo 2 temos: pH com níveis semelhantes, com diferença estatística não significativa. O volume total de saliva expelida pelo grupo 1 apresentou níveis bem abaixo ao dos pacientes do grupo controle, 2,75 (± 2,32) e 7,26 (± 1,26) respectivamente. A capacidade tampão também foi menor no grupo 1. Conclusão: as características gerais da saliva (pH, capacidade tampão e volume) foram mantidas após a hemodiálise. / The aim of the present study was to evaluate the pH, buffer capacity e salivary flow rate of the patients with renal chronic failure, before and after hemodialysis. Methodology: a transverse study, total of 55 patients in this distribution: convenience sample with 32 individuals (18 males, age mean of 59,5 years, ranging 28 to 87 years and 14 females, age mean of 48,2 years, ranging 30 to 83 years) submitted the hemodialysis in a particular clinical in Maceio – AL (group 1) and 23 individuals (12 males e 11 females with age median of 24 and 22 years respectively, ranging 21 to 29 years), composed by graduation stage from CESMAC University Center and Federal University of Alagoas (group 2, control). salivary flow rate was observed the amount of aspirate salivary in a 5 ml syringe. The pH was analyzed with pHmeter and buffer capacity was verified by addiction of 2% citric acid (2 mL). Statistical analysis was verified by ANOVA, Tukey, Kruskal-Wallis and Dunn. Results: The hemodialysis don`t promoted modification on the pH, rate and buffer capacity in salivary samples. Comparing group 1 and group 2 was showed that: pH present similar level, with no statistical diference. The total salivary rate of group 1 was three times less than control group, 2,75 (± 2,32) e 7,26 (± 1,26) respectively. The buffer capacity was less in group 1. Conclusion: the general features of salivary (pH, buffer capacity and flow rate) keeping the same after hemodialysis.

A capacidade reprodutiva de mulheres em tratamento dialítico é reduzida devido alterações hormonais, distúrbios de ovulação e menstruais. A gestação neste grupo é considerada rara e de risco. Nas últimas décadas, mudanças no tratamento para insuficiência renal crônica (IRC) resultaram em um aumento da fertilidade. Estudos relatam as possibilidades de sucesso nas gestações neste grupo. Este estudo, de natureza descritiva propôs investigar as informações que as mulheres urêmicas possuem acerca da gestação em mulheres que fazem tratamento hemodialítico, e identificar se a maternidade é desejada por estas mulheres. Utilizou-se como instrumento de coleta de dados: roteiro de entrevista semidirigida; Escala Diagnóstica Adaptativa Operacionalizada EDAO; as pranchas 1, 2, 3MF, 7MF e 16 do Teste de Apercepção Temática TAT. Participaram do estudo 23 mulheres em tratamento hemodialítico, na faixa etária entre 24 e 43 anos. Dezoito entrevistadas têm um ou mais filhos; apenas cinco entrevistadas não têm filhos. Sessenta e cinco por cento das mulheres manifestam desejo em ser mãe novamente. Vimos que há possibilidade de gravidez neste grupo onde 60% das mulheres têm vida sexual ativa, 60% menstruam mensalmente e apenas 52% fazem uso de método contraceptivo. A EDAO revelou que todas as entrevistadas encontram-se com adaptação ineficaz, sendo 18% com adaptação ineficaz leve, 39% com adaptação ineficaz moderada e 43% com adaptação ineficaz severa. As pranchas do TAT revelaram as dificuldades vivenciadas pela dependência à máquina de hemodiálise e quanto o suporte familiar é fundamental para lidar com as limitações pertinentes a condição de doente renal crônico. Os dados da pesquisa indicam que é importante a atenção da equipe de saúde à sexualidade das mulheres em diálise. Também é importante que o diálogo a respeito do planejamento familiar faça parte das intervenções da equipe / The reproductive capacity of women on hemodialysis is reduced because of hormonal changes, ovulation disturbs and menstrual disturbs. Pregnancy to this group is considered rare and risky. In the last two decades, some changes in the treatment to chronic renal disease have resulted in better life quality to patients, including the increase of fertility. Reports have been put on public relating the possibilities of success. This descriptive study has proposed to investigate how much uremic women are informed about pregnancy in their case, and identify if they wish to be pregnant. It was used as data collect: semi directed interview, Operational Adaptative Diagnostic Scale, and the boards 1, 2, 3MF, 7MF and 16 of Thematic Apperception Test TAT. The study included 23 woman with 24 43 age. Eighteen women have at least one child or more, just five of them do not have any children. The results has demonstrated they are not informed about pregnancy and hemodialysis treatment. Most of the women want to be pregnant, including those who have already been. We observed they are able to be pregnant because 60% of them have active sexual life, 60% menstruate monthly and just 52% avoid pregnancy with contraceptive method. Operational Adaptative Diagnostic Scale revealed that every interviewed woman is not adapted to the treatment (all of them considered their adaptation inefficient), 18% light inefficient adaptation, 39% moderated inefficient adaptation, and 43% severe inefficient adaptation. TAT boards revealed difficulties lived by the dependency to the hemodialysis machine, also revealed how much familiar support is important and fundamental to face the pertinent limits to chronic renal disease. The research data indicate it is important to the doctors to be attempted to womens sexuality. And it is also important that dialogue about familiar plan has to happen among the medical group intervention

Background: End-stage renal disease (ESRD) is a chronic medical condition where 90% or more of the kidneys are nonfunctional (Doig & Huether, 2014). The current treatment for ESRD is Hemodialysis [HD] (National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], 2013). Individuals who have ESRD who undergo HD suffer from tremendous symptom and treatment burden that affects various facets of life (Axelsson, Klang, Hagelin, Jacobson, & Gleissman, 2014; Axelsson et al., 2012; Tamura & Cohen, 2010). Unfortunately, the symptom and treatment burden associated with ESRD are underrecognized and undertreated (Feely et al., 2016; Gelfman & Meyer, 2012; Murtagh, Addington-Hall, & Higginson, 2007; Russon & Mooney, 2010; Tamura & Meier, 2013). Purpose: The purpose of this quality improvement project is to explore if ESRD patients in Davita Desert Dialysis are knowledgeable about palliative care and if providing education might change their behavior. The primary aim is to create awareness in patients about PC services in an effort to improve their quality of care through education. Design: A quantitative pre- and post survey approach using qualtrics software was utilized to assess the baseline and post-education knowledge of patients who met the inclusion criteria. Setting: DaVita Desert Dialysis, Sun City, AZ. Intervention: The educational intervention is the viewing of a three-minute voice over presentation about palliative care. Limitations: The sample size was small and exposes this study to marked bias and non-generalizability due to the limited number of recruited individuals. Results: One hundred percent of the individuals in the posttest had better awareness about and knowledge about PC. Conclusion: PC can improve the quality of life of patients that suffer from the undertreated and underrecognized symptom and treatment burden (Tamura & Meier, 2013). Further data and studies will be needed to establish PC in the field of nephrology as it relates to the ESRD population undergoing HD. However, the quality improvement focus of increasing PC awareness among ESRD patients undergoing HD has shown great promise as all participants had increased awareness, knowledge availability, and readiness for PC services.

Haemodialysis (HD) patients have a high mortality risk and most have echocardiographic evidence of abnormal cardiac structure or function. Markers, such as left ventricular hypertrophy (LVH), show association with adverse outcome in the general population and can aid in clinical decision making. The aim of this research was to explore the prognostic utility of established and novel two-dimensional (2DE) and three-dimensional transthoracic echocardiographic (RT3DE) techniques in HD patients. Adult maintenance HD patients from a single tertiary nephrology centre including satellite dialysis units were enrolled. Exclusion criteria were if patients were clinically unstable, unable to consent, or if required ambulance transportation for echocardiography visits. Consented patients underwent 2DE with speckle tracking (STE), RT3DE and VicorderTm measurements of pulse wave velocity (PWV) on a non-dialysis day, after the short inter-dialytic break. Clinical phenotype data, 3-month averaged blood results and dialysis prescriptions were obtained from the hospital electronic patient records. All patients screened were followed-up until death, renal transplantation, moving out of the region, or 16th November 2015. Regression analysis was used to assess the cross-sectional relationship between echocardiographic parameters. Relationship of echocardiographic parameters with outcome was assessed by Cox regression analysis. The first study explored whether patients recruited had similar characteristics and survival compared with patients who declined consent or who were excluded from the study. Patients who declined consent had an adjusted hazard ratio (HR) for all-cause mortality compared with recruited patients of 1.70, 95% confidence interval (CI) 1.10-2.52, and excluded patients had an adjusted HR of 1.30, 95% CI 0.75-2.25. Recruited patients may be a 'fitter' population and this needs to be considered when interpreting results. The second study reports that when global longitudinal strain (GLS) is combined in a multivariable model with PWV; PWV is superior to GLS in its association with mortality (adjusted HR 1.23, 95% CI 1.03-1.47 versus HR 1.00, 95% CI 0.86-1.17). When this analysis was repeated in a sub-group of patients with LVH, neither GLS nor PWV were associated with mortality, whilst both were prognostically significant in a preserved LVEF sub-group (PWV: HR 1.23, 95% CI 1.04-1.4 and GLS: HR 1.16, 95% CI 1.01-1.33). Therefore GLS has different prognostic implications in different patient sub-groups. The third study explored whether tissue motion mitral annular displacement (TMAD) measured by STE may be a more useful alternative to GLS as it measures strain but is quicker and less user-dependent. TMAD was closely correlated to GLS (r=-0.614, p<0.001), but had no prognostic power for mortality (adjusted HR 1.04,95% CI 0.91-1.19). The correlation between 2DE and RT3DE determined LV mass and volume measurements and the prognostic significance of RT3DE measurements were assessed. Although there was good correlation between 2DE and RT3DE LV volume measurements, 2DE overestimated LV mass compared to RT3DE. RT3DE measures gave no added prognostic value, and there were added difficulties in obtaining adequate images for RT3DE (35% of patients who had adequate 2D images). Furthermore, although RT3DE determined LV mechanical dyssynchrony index was prolonged in HD patients compared with published general population controls, it failed to show any prognostic significance (HR 2.16, 95% CI 0.96-4.89) for mortality, but was associated with hospitalisation for heart failure (HR 1.03, 95% CI 1.00-1.06). These results indicate that novel measurements of sub-clinical cardiac dysfunction have the potential to aid prognostication in this high risk population. Follow-up studies exploring the longitudinal change in these parameters is ongoing.

Introduction: Patients with acute kidney injury (AKI) in developing countries are described in a profile of young age, with less comorbidities, with unifactorial, and with a lower mortality compared to patients in developed countries. Objective: To assess mortality in patients with acute kidney injury undergoing hemodialysis (HD) and its associated factors in a developing country setting. Methods: Retrospective study. Demographic, clinical, and mortality variables were collected from patients who presented AKI and underwent HD between January 2014 and December 2015 at a national reference hospital in Lima, Peru. Risk ratios (RR) and 95% confidence intervals (95%CI) were estimated through Poisson regressions. Results: Data from 72 patients with AKI that underwent HD were analyzed, 66.7% of them were < 64 years old, and 40.2% of all patients died undergoing HD. Crude analysis showed higher mortality among those who used vasopressors, but lower mortality among those with creatinine values > 8.9 mg/ dL. The adjusted analysis showed that having had a creatinine level of > 8.9 mg/ dL, compared to a creatinine level of < 5.2 mg/dL at the time of initiating HD, was associated with 74% less probability of death. Conclusion: Four out of every ten AKI patients undergoing HD die. Higher levels of creatinine were associated with lower probability of mortality.

INTRODUCTION: The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. OBJECTIVES: To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients. METHODS: This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. RESULTS: We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97). CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients. INTRODUCCIÓN: La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis. OBJETIVOS: Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis. MÉTODOS: Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson. RESULTADOS: El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97). CONCLUSIONES: El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.

Introduction—Chronic kidney disease (CKD) affects 50 million people globally. Several studies show the importance of implementing interventions that enhance patients' knowledge about their disease. In 2011, the Kidney Disease Knowledge Survey (KiKS) was developed, a questionnaire that assesses the specific knowledge about CKD in pre-dialysis patients. Objective—To translate to Spanish, culturally adapt and validate the questionnaire KiKS in a population of patients with pre-dialysis CKD. Methods—The translation and cultural adaptation of KiKS was performed. Subsequently, its validity and reliability were determined. The validity was evaluated by construct validity; and the reliability by its internal consistency and its intra-observer reliability (test-retest). Results—A good internal consistency was found (Kuder-Richardson = 0.85). Regarding intraobserver reliability, the intraclass correlation coefficient with a value of 0.78 (95% CI: 0.5–1.0) indicated a good reproducibility; the mean difference of −1.1 test-retest S.D. 6.0 (p = 0.369) confirm this.

Background: With an increased understanding of dialysis-treated patients' experiences of waiting for a kidney transplant, the nurses can adjust their care based on patient's individual needs. A changed life situation that requires regular treatment and limiting the patient in their daily life makes it important that the nurse understands the patient's mood and is there to support. Aim: The aim of this study was to highlight the experiences of dialysis-treated patients waiting for a kidney transplant. Method: A literature study based on qualitative research. Friberg ́s five-step model was used for analyze of the articles and results in three main themes and six sub- themes. Results: This result showed that dialysis-treated patients awaiting a kidney transplant experienced both physical and mental barriers and stress. They experienced limitations in daily life as loss of freedom and financial difficulties. The patients' feelings oscillate between hope and uncertainty like an emotional roller coaster and they find support in their relatives, healthcare professionals or in their religion. Conclusion: The experiences of waiting for a kidney transplant are relatively similar, but strategies to get trough this process varies. Common for all patients were that it was a demanding and stressful time. Therefore it is important that nurses pay attention and adapt the care for each individual.

Vascular access (VA) is one of the most important determinants of outcomes in haemodialysis (HD). Poor VA outcomes have a significant adverse impact on patient experience, morbidity and mortality and also result in significant burden on the health economy. An arteriovenous fistula (AVF) is accepted as the best HD vascular access. However AVF prevalence is variable and AVFs are associated with a high early failure rate. A small but significant number of AVFs experience late failure further down the line. The purpose of this project, broadly, was to understand VA outcomes, focusing specifically on AVFs. This project involved a series of clinical studies that were specifically designed by the student researcher to investigate various time points in the life cycle of AVFs – from creation and maturation - to its use and subsequent failure. The MANVAS, OPEN and Coil embolisation studies focus on the early phase of AVF development and maturation, whilst, the VA in Home HD study investigates the impact of intensive self-use in a non-healthcare setting. It is followed by the prospective thrombosed vascular access study focusing on the late phase of VA failure. The MANVAS study, a prospective cohort study, was set up with an aim to follow up patients undergoing AVF formation with a view to defining the natural history and maturation process of AVFs, and determine factors which affect outcomes – demographic, clinical, and biological. The OPEN study was designed to investigate poor maturation due to anastomotic failure by the intervention of the OptiflowTM device. The results suggest high maturation rates that were significantly better than those reported in the literature. The coil embolisation study demonstrated that the intervention of coil embolisation is a safe and effective treatment option for failing AVFs with accessory draining veins. The Vascular Access in Home Haemodialysis (HHD) study demonstrated that VA outcomes are significantly better in HHD patients and unadjusted patient survival in the HHD cohort was associated with incident VA. The thrombosed access study is a prospective longitudinal study designed to assess the effectiveness of endovascular access salvage and investigation of factors that impact longer-term access survival. One of the major aims of the study was to analyse outcomes related to prompt restoration of flow for patients presenting with acute failure of fistulae and grafts. The study showed that timely endovascular salvage is highly effective in restoring immediate patency but long-term outcomes remain poor. It also confirms poor outcomes of grafts as compared to AVFs and demonstrates that progression to thrombosis in AVFs portends poorer prognosis. The endovascular technique of balloon maceration, compared to outcomes reported in the literature, appears to be equally safe and effective with no increased risk of clinically significant pulmonary embolism. The clinical studies in this thesis provide a unique insight into the different aspects of the lifecycle of an AVF, and pave the way for an improvement in our fundamental understanding of the natural history and biology of AVFs.