Vascular access for dialysis in diabetic patients

There is consent that arteriovenous fistulae as introduced by Brescia et al. (1) are the preferred choice in the field of vascular access for maintenance haemodialysis therapy. Worldwide, a rapidly growing population of older patients suffering from diabetes mellitus, mainly type 2, is observed. The pre-existing damage to the arterial and/or venous vascular anatomy and the high cardiovascular comorbidity makes it more difficult to construct and to maintain a well functioning arteriovenous fistula (AVF). Problems arise from specific complications of AVF in diabetic patients. Alternative types of vascular access are needed in case arteriovenous access fails completely or cannot be created. It is concluded that old and new techniques in creating, maintaining and revising vascular accesses should be critically revisited for the benefit of the diabetic patient. A new, particularly demanding field in nephrology asks for urgent answers.