BACKGROUND The most common complication of hemodialysis (HD) access graft is thrombosis. Clopidogrel, an inhibitor of platelet aggregation, was assessed to prevent this serious complication. METHODS A prospective study in which 24 patients on chronic HD whose vascular accesses were grafts were divided into two groups: group A (n = 12, 50%) consisted of patients who did not receive antithrombo...

This study of 533 vascular access sites for long-term hemodialysis in patients with end-stage renal disease, accumulating more than 12,000 patient months, indicated that primary arteriovenous fistula (AVF) is the procedure of choice. The group receiving primary AVF had the greatest duration of patency: 84% at three years compared to 70% for the group receiving polytetrafluoroethylene (PTFE) gra...

Registry data from around the world continue to report poor fistula maturation rates, and the majority of patients are starting dialysis with central venous catheters. In the USA in 2013, 80% of patients started dialysis with a catheter; a figure which has changed very little since 2005.[1] In the UK in 2011, 57% of patients started dialysis with a catheter.[2] Starting dialysis with a catheter...

The Fistula First Initiative has strongly encouraged nephrologists, vascular access surgeons, and dialysis units in the United States to make valiant efforts to increase fistula use in the hemodialysis population. Unfortunately, the rigid "fistula first" recommendations are not based on solid, current, evidence-based data and may be harmful to some hemodialysis patients by subjecting them to pr...

Central venous stenosis is a well-known complication in patients with vascular access for hemodialysis. We report two cases involving patients on hemodialysis with arteriovenous fistulas who developed reversible unilateral conductive hearing loss secondary to critical stenosis of central veins draining the arteriovenous dialysis access. A proposed mechanism for the patients' reversible unilater...

In March 2010, the Center for Medicare and Medicaid Services (CMS) convened several clinical technical expert panels (C-TEP) to provide recommendations for improving various aspects of hemodialysis management. One of the C-TEPs was tasked with recommending measures to decrease vascular access-related infections. The members of this C-TEP, who are the authors of this manuscript, concluded unanim...

Renal failure and infectious disease are strongly associated with morbidity and mortality in patients with severe generalized recessive dystrophic epidermolysis bullosa (RDEB-sev gen). However, it is reportedly difficult to introduce hemodialysis with an arteriovenous fistula (AVF). We encountered a 32-year-old man with RDEB-sev gen in whom hemodialysis with a native AVF was introduced that fav...

over a seven year period from 1982 to 1989,3337 conduits were created in 3137 patients with end stage renal disease (esrd) as access for chronic dialysis. these included 2690 side-to-side arteriovenous fistulae (a vf), 168 end-to-side a vfs, 10 autogenous vein grafts, 51 homogenous frozen vein grafts, 109 polytetrafluoroethylene (ptfe) grafts, 209 emergency external arteriovenous shunts, three ...

IMPORTANCE Arteriovenous fistula (AVF) access improves survival in patients with end-stage renal disease (ESRD) compared with other modalities when used at first hemodialysis. Use varies between locations, but, to our knowledge, no study has related this finding to mortality on a national scale. OBJECTIVE To quantify regional variation in AVF access at first hemodialysis, as well as the assoc...

Patients undergoing hemodialysis are at risk for bloodstream infections (BSIs), and preventing these infections in this high-risk population is a national priority. During 2008, an estimated 37,000 BSIs related to central lines occurred among hemodialysis patients in the United States. This is almost as many as the estimated 41,000 central line-associated BSIs that occurred during 2009 among pa...