Vascular Access for Hemodialysis: When and how?

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As chronic kidney disease (CKD) progresses to the terminal stage, proper actions must be taken to prepare the patient for the initiation of the renal replacement therapy (RRT). If hemodialysis is an option for RRT, decisions should be made about the right vascular access for each individual patient. The available options for vascular access include the use of native arteriovenous fistulas (AVF), synthetic arteriovenous grafts (AVG) and double lumen dialysis catheters. With the help of ultrasound mapping, chances for choosing a right access are today very high. For hemodialysis patients the selection of the proper vascular access is of vital issue in regard of preventing complications and unnecessary procedures. Planning, creation and monitoring of the vascular access in dialysis patients should involve not only the nephrologist, but also the vascular surgeon and the interventional radiologist. Thus, multidisciplinary approach should be taken, in order to choose the way that has the most advantages and the least damage for the patient. That is the proper mode for hemodialysis patients to have longer and better quality of life.

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