Dialysis access for End Stage Renal Disease (ESRD)

The key function of the kidneys is to clear toxins from the blood. When they fail, however, the patient might need dialysis to filter out the toxins. This can be temporary using catheters placed in the neck. If more permanent dialysis is required, an arteriovenous fistula or graft can be placed in the arm.

ESRD is a major health problem that can result from a variety of reasons. The nephrologist is usually in charge of taking care of medical management. Surgeons can provide access for dialysis.

What is dialysis access?

In order to perform dialysis and filter the blood from toxins, the patient needs to be connected to the dialysis machine. There are temporary and permanent options.

Temporary options consist of a variety of catheters that can be placed in the neck or in the groin. These can be short-term catheters (that can stay in place for up to 10-14 days) and long-term catheters (that can stay in place for a few weeks to months)

Permanent dialysis options are typically placed in the arm but can also be placed in the groin. They include arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).

An AVF is created using the patient’s own veins. The surgery is usually performed on an outpatient basis. It involves connecting a vein to an artery. An AVF takes 6-8 weeks to mature (grow bigger and thicker) to the extent that dialysis nurses can stick needles into it and use it for dialysis.

If the patient has small veins, an AVG is usually the better option. It also placed on an outpatient basis. Most AVGs can be used within a couple of weeks of placement. Some can be used as early as the day following surgery.

Which dialysis access is best?

There are multiple factors. If urgent dialysis is needed then a catheter will need to be placed. Catheters should be taken out as soon as possible to avoid long term complications like infection, clogging, and scarring of the big veins in the chest.

For long-term dialysis, AVFs are best as they last longer and are less prone to becoming infected or clogged up. An AVG is a suitable option if a patient has small veins that are unlikely to mature.