Hemodialysis Vascular Access: The Perils and Potentials

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 is associated with an 8‐fold increase in rates of infection requiring prolonged hospital admissions, with a ≤1.4 million spend on methicillin‐resistant Staphylococcus aureus infection.[3] A Canadian study reported that the failure of a first fistula was associated with a doubling of the cost of vascular access care in the 1st year of hemodialysis.[3] As the number of dialysis patients increases globally, the extra costs associated with vascular access complications continues to deplete already stretched healthcare resources. In the UK, the Department of Health responded by introducing a financial incentive; providing extra remuneration to dialysis centers for patients dialyzed through a fistula or graft, with a tariff uplift of 33%.[4] In India, the situation is challenging, the number of hemodialysis patients is rising, vascular access is not a priority among hemodialysis providers, and the cost for the patients is huge.[5]