Choice of dialysis access: Catheter, peritoneal, or hemodialysis

Abstract

The most recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines shifted emphasis to kidney replacement modality selection and vascular access planning and creation of the Endstage Kidney Disease Life-Plan, which promotes a patient-centered approach. The Life-Plan is intended to be created through discussions between the patient and their multidisciplinary care team to ultimately develop a lifelong kidney replacement therapy strategy. The focus of the Life-Plan is to engage the patient in a multidisciplinary patient-centered approach. The Life-Plan includes selection of the most suitable treatment modality (eg, hemodialysis, peritoneal dialysis, or transplantation), setting (home or center), and type of vascular access. Ultimately, this approach considers overall patient health, preferences, and anatomic factors. Patients choose between hemodialysis, which can be performed either in center or at home, and peritoneal dialysis. When considering vascular access, options consist of tunneled dialysis catheter, arteriovenous fistula, and arteriovenous graft. Each modality and vascular access type has benefits and disadvantages that should be weighed carefully with the patient and their supportive team to arrive at a decision that aligns as closely as possible with each individual patient's circumstances.