Your nephrologist may have informed you that you have advanced kidney disease, also called end stage renal disease (ESRD), and that dialysis treatment is necessary. This condition affects more than 468,000 U.S. residents currently receiving dialysis.

Hemodialysis is the process of circulating blood through an artificial kidney to remove waste and excess fluid. To receive these treatments, a functioning vascular access is required — a port allowing blood to flow from the body to the dialysis machine and back. Without it, the life-preserving treatment of dialysis would not be possible.

Types of Vascular Access

A vascular access must be created before beginning regular hemodialysis. There are four basic kinds:

  • Arteriovenous (AV) fistula
  • AV graft
  • Central venous catheter (CVC)
  • Hemodialysis reliable outflow (HeRO) graft

AV Fistula

An AV fistula is a natural vascular access where a person's own artery is surgically connected to a vein, typically in the arm or leg. Performed as an outpatient procedure using local anesthetic, the increased blood flow causes the vein to grow bigger and stronger.

Fistulas require advance planning, typically taking two to four months to develop. Once mature, they provide good blood flow for many years. Kidney experts consider the fistula the "gold standard" because patients experience fewer complications like infection or clotting.

Fistula advantages:

  • Lower infection risk than other access types
  • Lower clotting risk than other access types
  • Better overall performance
  • Greater blood flow capacity
  • Longest lifespan among access types

AV Graft

If veins are too small to develop properly into a fistula, a synthetic tube can be implanted under the skin. This artificial vein allows repeated needle placement during hemodialysis. Unlike fistulas, grafts do not require development time and can be used within two to three weeks.

Compared to fistulas, grafts experience more clotting and infection problems and need replacement sooner, though a well-maintained graft can last several years.

Central Venous Catheter (CVC)

When kidney disease progresses rapidly, there may not be time for a permanent access before dialysis begins. A catheter — a tube inserted into a vein in the neck, chest, or groin area — can serve as temporary access. It has two chambers for two-way blood flow without requiring needle insertion.

Catheters are not ideal for permanent use, as they risk clogging, infection, or vein narrowing. They can function for several weeks or months while permanent access develops.

HeRO Graft

The HeRO graft is designed for patients with damaged or blocked central veins who depend on catheters. The central veins to the heart can become damaged or blocked over time, causing fistulas and grafts to fail.

This newer option provides an alternative to long-term catheter use, which carries high infection rates and lifestyle limitations.