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Vascular access for hemodialysis

Nature Clinical Practice Nephrology volume 2, pages 504–513 (2006)Cite this article

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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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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