| Summary: | Successful haemodialysis depends on the availability of safe, efficient, and durable access to the vascular tree. This can be provided by creation of an arteriovenous fistula, insertion of a synthetic vascular graft or insertion of a central venous catheter. Established haemodialysis vascular access is associated with a number of important complications which can impact significantly on both the quality of life and survival of haemodialysis patients. The primary aim of this thesis was to perform a detailed evaluation of the risks to health conferred by haemodialysis vascular access and its maintenance in patients with advanced renal failure. The work described in this thesis describes the relative strength and independence of association between haemodialysis vascular access type and risk of mortality, bacteraemia and catheter thrombosis. Greater clarity is demonstrated on the relative effect of heparin-based haemodialysis catheter lock solutions on markers of systemic coagulation in vivo, whilst the in-vitro variability of antimicrobial activity against planktonic and biofilm-embedded staphylococci achieved with catheter lock solutions containing heparin and vancomycin, alone and in combination, is clearly shown. New insights are gained into the benefits of contrast magnetic resonance venography as a tool for demonstrating thrombosis and stenosis of the central veins in the assessment of vascular access in haemodialysis patients. Similarly, the emergence of a new disease, nephrogenic systemic fibrosis was found and its association with gadolinium-enhanced magnetic resonance imaging was explored in detail.
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