The 4 most common vascular access types for dialysis
In order to carry out dialysis treatment, a link between your body fluids and the therapy system must be created. This is true for both hemodialysis (HD) and peritoneal dialysis (PD). Such a "gateway" into your body is what is meant by access in this article.
For hemodialysis, there are three common access points: AV fistula, graft, and dialysis catheter. In addition, there are a few more options and variations for special, rarer cases. However, we will not go into these in detail here.
Similarly, with peritoneal dialysis, you need a peritoneal dialysis catheter.
Hemodialysis option 1: the AV fistula
Colloquially known as a fistula, this is the most common and preferred method of enabling hemodialysis. AV fistula stands for arteriovenous fistula - it is also called a native shunt or simply a shunt. It is a connection between an artery and a vein. This is done to allow sufficient blood flow. A doctor calls such a connection of two blood vessels an anastomosis.
After the creation of an AV fistula, you have to exercise the fistula daily, for example with a "stress ball", until it is ready for dialysis after 4-6 weeks. Gently palpate your shunt daily to get a feel for how it feels when it is in good condition. If something should change in your flow rate, you will be able to detect it faster and go to the hospital right away. By the way, both needles are placed in your vein during the HD, the artery remains untouched.
Hemodialysis option 2: the graft
If an AV fistula method cannot be applied for reasons such as poor blood vessel status, the next option is to use a graft. In principle, it works like an AV fistula, but the artery and vein are connected with a plastic material. The most common material used today is a PTFE prosthesis from the company Gore. This is why it is sometimes referred to as a "Gore-Loop" or "Gore-Tex-Shunt".
Hemodialysis option 3: the dialysis catheter
If the first two options do not work, a catheter is inserted into large vessels. This is usually a central venous catheter and can be temporary or long-term. Temporary catheters must be used, for example, when the AV fistula is not ready or suddenly stops working. Because the dialysis catheter has an increased risk of infection, it is used less often, if other options are available. Actually, for a dialysis center, the share of catheter dialysis treatments is even a quality parameter. This share should therefore be as low as possible.
Peritoneal dialysis: the PD catheter
In peritoneal dialysis, vascular access is also achieved via a catheter. This catheter is inserted into your abdominal cavity through a small surgery. Simply put, this means that you have a straw that goes into your abdomen. For good long-term dialysis results, the catheter should be implanted by an experienced doctor. The catheter remains in your abdominal cavity. Careful and hygienic handling is therefore particularly important.
What are dialysis crashes?
It is not uncommon for people to become aware of the deterioration of their kidneys at a very late stage and suddenly have to start dialysis. These cases are often referred to as "dialysis crashes." Due to a lack of alternatives, these dialyses must then be performed via dialysis catheter until an alternative vascular access is ready. To avoid this, it is very important that you learn about dialysis early on. It is the only way to ensure that you can dialyze right from the start with a fistula, graft or PD catheter. It's for your own health and safety!
To be able to dialyze, you need a vascular access - a gateway that allows the body and the therapy system (e.g. the hemodialysis machine) to work together
For HD, there are three common types of access: AV fistula, graft, and a dialysis catheter. The AV fistula should always be the first choice due to lower health risks
Peritoneal dialysis requires a catheter to be placed in the abdomen to allow fluid exchange in the abdominal cavity
- Allon, M. Vascular Access for Hemodialysis Patients. New Data Should Guide Decision Making. CJASN June 2019, 14 (6) 954-961; DOI: https://doi.org/10.2215/CJN.00490119