Potential of Fat-Derived Stem Cells to Prevent Dialysis Access Failure

Researchers at the Mayo Clinic have explored an innovative approach to improve outcomes for patients requiring hemodialysis by using stem cells derived from fat tissue. During arteriovenous fistula (AVF) surgeries, which create the necessary access point in the arm for dialysis, a common complication is the narrowing or stenosis of the vessel, which can render the access useless. This process, known as stenosis, often results from neointimal hyperplasia—excessive growth of the vessel’s inner layer—and inflammation.

In a phase 1 clinical trial, Dr. Sreenivasulu Kilari and his team administered autologous mesenchymal stem cells—found abundantly in fat tissue—along the surgically created fistula during the procedure. These cells were carefully placed along the outer vessel layer (adventitia) by dripping them onto the vessels over five minutes, aiming to prevent narrowing and reduce inflammation.

The study involved 21 patients, with 11 receiving the stem cell treatment. Results showed that patients who received stem cells experienced faster fistula maturation and wider vascular openings capable of handling dialysis-related blood flow, compared to those who did not receive the treatment. Additionally, the treated patients exhibited lower levels of inflammation-related gene activity, which is associated with vessel narrowing.

Animal studies supported these findings, revealing that mesenchymal stem cells promote vascular health when delivered during AVF surgery. The mechanism involves anti-inflammatory effects and support of vessel remodeling, suggesting that these stem cells could be a promising therapy to address the high failure rate of AVFs in end-stage kidney disease patients.

The prevalence of chronic kidney disease affects over 800 million people globally, and many of these patients require hemodialysis, which depends on functional arteriovenous access. The failure of AVF due to stenosis affects around 60% of cases and can lead to repeated surgeries. The introduction of fat-derived mesenchymal stem cells may help improve fistula maturation, reduce complications, and extend the lifespan of dialysis access points.

While these initial results are promising, further studies and FDA approval are needed before this treatment can be widely adopted. The research conducted by Mayo Clinic presents a hopeful outlook for enhancing dialysis outcomes and managing chronic kidney disease complications more effectively.