Vascular Access for Home Hemodialysis: A Perspective on Tunneled Central Venous Catheters at Home.
An expert consensus perspective argues that tunneled hemodialysis central venous catheters can be an appropriate, individualized vascular access option to support expansion of home hemodialysis when a mature arteriovenous access is not available.
Background
Expansion of home hemodialysis (HHD) offers an opportunity to improve clinical outcomes, reduce cost of care, and address staffing challenges in the management of kidney failure on replacement therapy. A recognized barrier to wider HHD adoption is vascular access; although tunneled hemodialysis central venous catheters (CVCs) have been used for decades, clinicians often hesitate to send patients home without a mature, functional arteriovenous access.
Key recommendations
An expert panel of clinicians reviewed the literature and generated consensus recommendations on the use of CVCs for HHD. Consistent with the most recent vascular access guidelines, the panel recommends that an end-stage kidney disease life plan be created through shared decision making for modality choices, with the corresponding dialysis access individualized for each patient. For some patients, a CVC may represent the most appropriate vascular access to enable home hemodialysis.
Clinical implications
Reframing tunneled CVCs as a legitimate, patient-centered access option in selected cases may help overcome a key barrier to HHD expansion. The perspective situates catheter use within an individualized life-plan framework rather than as a default of last resort, while acknowledging that arteriovenous access remains preferred where feasible.
Category
Guidelines
Source
Kidney Med
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