Dialysis access: an increasingly important clinical issue.

ABSTRACT

Dialysis access, including vascular access for hemodialysis and peritoneal access for peritoneal dialysis, is critical in the clinical care of patients with end-stage renal disease. It is associated with increases in morbidity, mortality, and health care costs. A number of problematic issues are involved, some of which are addressed in this paper with reference to the most recent publications, including the inappropriately low prevalence of peritoneal dialysis in Western countries, which is relevant to access placement in the pre-dialysis stage; the excessively high use of central venous catheters in incident and prevalent dialysis patients; the diagnosis and treatment of steal syndrome; the advantages and limitations of antiplatelet therapy; and finally, the correct pre-operative evaluation and subsequent surveillance of the vascular access.