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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Vascular access for hemodialysis: current perspectives.

Domenico Santoro1, Filippo Benedetto2, Placido Mondello3

  • 1Department of Clinical and Experimental Medicine, Unit of Nephrology, University of Messina, Italy.

International Journal of Nephrology and Renovascular Disease
|July 22, 2014
PubMed
Summary

Vascular access for hemodialysis includes native arteriovenous fistulas (AVF), grafts, and central venous catheters (CVC). AVFs are preferred for longevity and fewer complications, while CVCs carry higher infection and hospitalization risks.

Keywords:
arteriovenous fistulacentral venous catheterinfectionprosthetic grafts

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Infectious Diseases

Background:

  • Efficient hemodialysis (HD) relies on well-functioning vascular access (VA).
  • Key VA types include native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC).
  • Guidelines recommend AVF as the primary choice for chronic HD due to superior longevity and lower morbidity/mortality.

Purpose of the Study:

  • To review the different types of vascular access for hemodialysis.
  • To discuss the advantages and disadvantages of each access type.
  • To emphasize the importance of a multidisciplinary VA team for optimal patient care.

Main Methods:

  • Literature review of vascular access types for hemodialysis.
  • Comparison of complication rates, longevity, and infection risks associated with AVF, grafts, and CVCs.
  • Discussion of optimal insertion sites and associated risks for CVCs, considering comorbidities like pacemakers.

Main Results:

  • Native arteriovenous fistulas (AVF) offer the best longevity and lowest complication rates.
  • Central venous catheters (CVCs) are associated with higher risks of infection (30-60% removal rate) and hospitalization.
  • Subclavian vein insertion for CVCs carries a high thrombosis risk, with overall CVC complications ranging from 5% to 19%.

Conclusions:

  • AVF remains the preferred vascular access for chronic hemodialysis.
  • Careful risk-benefit assessment is crucial for CVC insertion, especially in patients with implanted devices.
  • A multidisciplinary vascular access team is essential for providing optimal care to hemodialysis patients.