Improving dialysis access management

Renal replacement therapy requires either placement of a functional hemodialysis vascular access or peritoneal dialysis catheter. Early provision of a dialysis access improves patient care with reduction in morbidity and reduces the economic burden incurred as a result of delayed access placement. Vascular access dysfunctions (thrombosis and infection) pose the greatest burden on the end-stage renal disease population. This article reviews the current literature on the planning of dialysis access, with particular emphasis on issues pertaining to vascular access. Current concepts to maximize access patency and efficiently manage vascular access complications are highlighted.