Dialysis access

If you have severe chronic kidney disease but have not yet developed kidney failure, talk with your doctor about which type of dialysis may be best for you. The type of dialysis you receive will help determine the type of dialysis access you need.

Hemodialysis

Before you can start hemodialysis, your doctor must create a way to access your bloodstream (vascular access). This access is meant to be permanent so that it can be reused for each dialysis session. The different types of access for hemodialysis include:

• Fistula. A fistula is created by connecting one of the arteries to one of the veins in your lower arm. A fistula allows repeated access for each dialysis session. It may take about 6 to 12 weeks for the fistula to form. A fistula may not clot as easily as other dialysis access methods. A fistula is the most effective dialysis access and the most durable. Complications include infection at the site of access and clot formation (thrombosis).
• Graft. A graft uses a synthetic tube implanted under the skin in your arm to connect an artery and a vein. The tube becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. This type of access may be used if you have very small veins. A graft does not need to develop as a fistula does, so a graft can sometimes be used as soon as 1 week after placement. Compared with fistulas, grafts tend to have more problems with clotting or infection and need to be replaced sooner. A polytetrafluoroethylene (PTFE or Gore-Tex) graft is the most common type used for hemodialysis.
• Venous catheter. A tube, or catheter, may be used temporarily if you have not had time to get a permanent access. The catheter is usually placed in a vein in the neck, chest, or groin. Because it can clog and become infected, this type of catheter is not routinely used for permanent access. But if you need to start hemodialysis right away, a catheter may be used while your permanent access develops.

Peritoneal dialysis access

Peritoneal dialysis requires placing a catheter in the belly. Placement is usually done 10 to 14 days before dialysis starts. Some peritoneal dialysis catheters may be used immediately (acute-use catheters). But because of a high risk of complications with prolonged use, these catheters are not commonly used.

What to think about

Many people are not able to plan for their dialysis because of emergency problems that require immediate dialysis. In these cases, a temporary catheter access will be placed until a fistula has been created in the arm or until a peritoneal dialysis catheter is placed in the belly.