Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial

Area of Science:

• Nephrology
• Vascular Access
• Dialysis Techniques

Background:

• Canadian guidelines identify arteriovenous fistula (AVF) cannulation technique as a research priority for home hemodialysis.
• Potential differences in complications between cannulation methods require investigation.

Purpose of the Study:

• To determine the feasibility of randomizing patients undergoing end-stage kidney disease (ESKD) training for home hemodialysis.
• To compare buttonhole versus stepladder cannulation of the AVF.
• To assess training time, needling pain, complications, and cost by cannulation technique.

Main Methods:

• A randomized trial was designed across seven Canadian hospitals.
• Patients training for home hemodialysis were assessed for eligibility and randomized to buttonhole or stepladder AVF cannulation.
• Data collected included training time, pain scores, and complications over 12 months.

Main Results:

• Recruitment occurred from November 2013 to November 2015, with 158 patients starting home hemodialysis training.
• Only 14 of 50 eligible patients (28%) consented to participate, with technique preference being the main reason for refusal.
• Buttonhole cannulation showed shorter training times but no reduction in pain or complications compared to stepladder.

Conclusions:

• It was not feasible to conduct a randomized controlled trial comparing buttonhole and stepladder AVF cannulation in Canada.
• Low patient enrollment and high refusal rates due to technique preference prevented meaningful conclusions.