Vascular access should be tailored to the patient

Area of Science:

• Nephrology
• Vascular Surgery
• Chronic Kidney Disease Management

Background:

• Hemodialysis relies on functional and durable vascular access.
• Chronic kidney disease (CKD) patients require a renal replacement therapy plan and access site protection.
• Vascular access selection is influenced by patient age, comorbidities, vessel quality, prognosis, urgency, and surgeon preference.

Purpose of the Study:

• To review factors impacting vascular access selection in CKD patients.
• To develop a clinical decision tree for dialysis access in CKD patients.
• To emphasize patient-centered vascular access care focused on maximizing survival and preserving future options.

Main Methods:

• Review of patient factors influencing vascular access choice.
• Analysis of recently published data on dialysis access.
• Development of a clinical decision tree for guiding access selection.

Main Results:

• Identification of key factors: age, comorbidity, vessel quality, prognosis, dialysis urgency, surgeon preference.
• Creation of a clinical decision tree to aid in patient-specific access selection.
• Shift in focus from primary patency to long-term patient survival and access option preservation.

Conclusions:

• Vascular access selection requires a comprehensive, patient-centered approach.
• A clinical decision tree can optimize dialysis access planning for CKD patients.
• Maximizing patient survival and preserving future access options are paramount in vascular access care.