Hemodialysis Vascular Access: Core Curriculum 2025

Area of Science:

• Nephrology
• Vascular Surgery
• Dialysis Access Management

Background:

• Hemodialysis is crucial for most patients with kidney failure.
• Functional vascular access is essential for effective hemodialysis.
• Current management strategies require a structured, patient-centered approach.

Purpose of the Study:

• To review major vascular access types for hemodialysis.
• To outline a comprehensive P-L-A-N (Patient ESKD Life-Plan first then Access Needs) framework for vascular access.
• To emphasize multidisciplinary, patient-centered management of vascular access.

Main Methods:

• Review of major vascular access modalities: arteriovenous fistula, arteriovenous graft, and central venous catheter.
• Detailed examination of vascular access planning, preparation, creation, use, and maintenance.
• Introduction of the P-L-A-N framework encompassing Patient ESKD Life-Plan and Access Needs.

Main Results:

• Common complications include stenosis and thrombosis (arteriovenous accesses) and dysfunction and infection (central venous catheters).
• Potentially life-threatening issues like access rupture and high-output cardiac failure are underrecognized.
• The P-L-A-N framework provides a structured approach to access management.

Conclusions:

• Effective vascular access management is vital for hemodialysis patients.
• A coordinated, multidisciplinary, patient-centered approach is necessary.
• The P-L-A-N framework supports optimal vascular access planning and preservation.