Who needs dialysis access?
People who need dialysis access have renal disease. This can be acute or chronic. Often times acute renal failure will improve and does not need long term dialysis access. Most people with chronic kidney disease are followed by a kidney doctor. As a patient’s renal function decreases they are often referred to a vascular surgeon. Typically the first time a patient sees a vascular surgeon is when a patient’s GFR (glomerular filtration rate), a measure of renal function, is 20-25. This is the ideal time to first see a vascular surgeon so that your surgeon can have the greatest likelihood of creating access using a patient’s own veins.
What types of dialysis access are there?
There are many types of dialysis access. The ideal dialysis access uses a patient’s forearm and the patient’s own vein. In order to create this kind of access patients need to have good arterial blood flow and veins that are not only big enough to use but have no scarring. If there are no veins large enough for dialysis access in the upper extremity a synthetic tube needs to be used to create the dialysis access. The type of tubing varies. Several of the most common types of synthetic accesses include PTFE (also known as gortex) and treated cow vessels.
What are the possible complications of dialysis access?
The most common complication of dialysis is for the access to become clotted and nonfunctional. Often this can be fixed with a short out patient procedure where the clot is removed with wires and catheters or a small incision. Sometimes the access needs an open revision in the operating room to adequately fix the underlying problem.
Some accesses can get infected. This is more common in synthetic accesses. This isn’t uncommon. Patients should tell their dialysis center or vascular surgeon if they have any fevers or chills or if they notice and redness or skin breakdown around their stick sites. Depending on the extent of the infection, a patient may require IV antibiotics, partial excision or complete excision of their dialysis access. This is a decision made between your surgeon and medical physicians.
Another common complication is “steal”. This phenomenon occurs when too much blood goes into the dialysis access and not enough blood travels to the hand. Most people have minor aching or pain in their hands with steal. Some have severe pain during dialysis and others develop necrosis of their fingers. There are several different options to treat steal. Patients need to talk to their vascular surgeon as soon as they notice any of these symptoms or if the symptoms worsen so he or she can minimize symptoms.