Vascular access for hemodialysis

A well-functioning vascular access for hemodialysis plays a key role in the quality of life and clinical outcome of dialysis patients. A vascular access for dialysis is considered to be adequate when it provides a blood flow of at least 250 ml/min in the standard dialysis and up to 350-400 ml/min in the high-efficiency dialysis. So far, Cimino-Brescia arterio-venous fistula still remains the gold standard among the available vascular accesses. It should be the first-choice vascular access. Unfortunately, due to the growing age of patients requiring dialysis, to the late-referral phenomenon, to the poor forearm vascular district, and to the increase in acute forms of renal disease, the use of vascular prostheses and central venous catheter becomes more and more frequent. The most important complications of vascular access are stenoses, thromboses, infections. Infections, more frequent in synthetic vascular access than in native fistulas, are responsible for the increase in patients' morbidity and, consequently, in public health costs. An integrated multi-professional approach of vascular access, involving nephrologists, vascular surgeons, interventional radiologists, and trained dialysis nurses should be implemented in order to early detect vascular access complications and failure.