Vascular Access for Hemodialysis

Vascular access is the lifeline for patients treated with chronic hemodialysis (HD). The vascular access choice should align with the patient’s end-stage kidney disease (ESKD) Life-Plan. The goal is to be able to achieve reliable function hemodialysis access with as few complications as possible. To do so, the needs of each vascular access (access needs) should be considered and include the insertion/creation plan, contingency plan, succession plan, and vessel preservation plan. Arteriovenous (AV) access (fistula and grafts) is preferred over central venous catheters (CVCs) whenever feasible. The major drawback of AV fistulas is that a high proportion fail to mature. The main problem with AV grafts is stenosis and thrombosis leading to reduced patency. Timely diagnosis and treatment of complications such as nonmaturation, stenosis and thrombosis, and access-induced ischemia are important to improve clinical outcomes. Long-term use of CVCs may be indicated in patients for whom AV access is not possible. The main problems with CVCs include infection and central venous obstruction.