Vascular access for dialysis: recent lessons and new insights
- 1 March 2009
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Nephrology and Hypertension
- Vol. 18 (2), 116-121
- https://doi.org/10.1097/mnh.0b013e328325d635
Abstract
Vascular access complications are a major cause of excessive morbidity and mortality in the dialysis population. This review will focus on recent changes in vascular access practices and access management directly affecting patient outcomes. The proportion of patients dialyzing via arteriovenous fistulas continues to increase as a result of national initiatives. Maturation failure is now the main obstacle to successful use of fistulas. Arteriovenous grafts remain an important vascular access option for dialysis, and interventions to prevent progression of stenosis are being explored. Central venous catheter prevalence has increased and new interventions to address catheter-related complications such as thrombosis and infection are promising. Advances in understanding the factors related to fistula maturation failure will have a major beneficial effect on vascular access outcomes. New approaches to prevent graft and catheter-related complications should complement advances on fistula management. Optimal patient selection for specific access modalities and institution of timely access interventions tested in rigorous clinical trials should be the next step to improve access management.Keywords
This publication has 51 references indexed in Scilit:
- Increased Hemodialysis Catheter Use in Canada and Associated Mortality RiskClinical Journal of the American Society of Nephrology, 2008
- Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis: review of the evidenceNephrology Dialysis Transplantation, 2008
- Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical GuideThe Journal of Vascular Access, 2008
- Trends in Hemodialysis Vascular Access From the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) 2000 to 2005American Journal of Kidney Diseases, 2007
- Fistula First InitiativeClinical Journal of the American Society of Nephrology, 2007
- Current Management of Vascular AccessClinical Journal of the American Society of Nephrology, 2007
- Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of LifeClinical Journal of the American Society of Nephrology, 2007
- Increasing the Use of Arteriovenous Fistula in HemodialysisClinical Journal of the American Society of Nephrology, 2007
- Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)Clinical Journal of the American Society of Nephrology, 2007
- Improving Outcomes for Dialysis Patients in the International Dialysis Outcomes and Practice Patterns StudyClinical Journal of the American Society of Nephrology, 2006