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Vascular access for hemodialysis

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From Nature Clinical Practice Nephrology

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Abstract

Establishing and maintaining adequate vascular access is essential to providing an appropriate dialysis dose in patients with end-stage renal disease. Complications related to vascular access have a significant role in dialysis-related morbidity and mortality. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guideline for dialysis access was last updated in 2000 and provides a framework for the optimal establishment and maintenance of dialysis access, and treatment of complications related to dialysis access. This paper reviews the 2000 K/DOQI dialysis access guideline as well as updated information published subsequently.

Key Points

  • In order of preference (based on duration of patency, and associated complications), types of vascular access for hemodialysis in end-stage renal disease patients are the native forearm arteriovenous fistula (AVF), the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter

  • Complications associated with vascular access included stenosis and thrombosis, infection, digital ischemia, heart failure, pseudoaneurysm and aneurysm

  • Consensus guidelines for vascular access were published in 2000 by the Kidney Disease Outcomes Quality Initiative; updated guidelines are expected in 2006

  • Vigilant monitoring and rapid intervention are required if complication-related vascular access failure is to be avoided

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Figure 1: Diagram illustrating end-to-side, radial–cephalic (wrist) and side-to-side, brachial–cephalic (elbow) primary AV fistulas.

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Acknowledgements

We thank L Spergel for providing Figure 1. R Hayashi is supported by NIH training grant T32-DK07789. AR Nissenson is supported, in part, by the Richard Rosenthal Dialysis Fund.

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Authors and Affiliations

  1. UCLA Medical Center,

    Rick Hayashi, Edmund Huang & Allen R Nissenson

  2. UCLA Medical Center,

    Rick Hayashi, Edmund Huang & Allen R Nissenson

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Rick Hayashi, Edmund Huang & Allen R Nissenson

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  1. Rick Hayashi
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  2. Edmund Huang
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Correspondence to Allen R Nissenson.

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Hayashi, R., Huang, E. & Nissenson, A. Vascular access for hemodialysis. Nat Rev Nephrol 2, 504–513 (2006). https://doi.org/10.1038/ncpneph0239

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