Vascular Access Considerations in Home Hemodialysis.
In this perspective on home hemodialysis, a reliably functioning vascular access is framed as the patient's lifeline, with the arteriovenous fistula generally preferred; patient training, complication monitoring, and program-level quality metrics are central to minimizing adverse events and technique failure.
Background
Global interest in expanding home dialysis utilization has grown because home hemodialysis (HHD) offers multiple clinical and quality-of-life benefits for patients with end-stage kidney disease (ESKD). Central to successful HHD is the establishment and maintenance of a functioning vascular access, which serves as the patient's lifeline while on therapy. This perspective describes what is currently known about the various vascular access options in HHD and elucidates what must be considered in selecting and caring for that access.
Key considerations
The selection of a vascular access type is influenced by individual patient circumstances, but the arteriovenous fistula is generally the preferred access method. Because patients use and manage their own access at home, training requires attention to safety, risk management, and monitoring for complications in order to minimize adverse events and technique failure.
Clinical implications
The authors argue that HHD programs should incorporate systematic frameworks for quality improvement and assurance, together with the measurement of metrics relating to vascular access, as tools to enhance the value of care delivered. Careful, individualized selection and diligent care of the vascular access are presented as prerequisites for sustaining patients on home hemodialysis.
Category
Research
Source
Clin J Am Soc Nephrol
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