When kidneys fail, hemodialysis takes over the job of cleaning the blood. To do this safely, doctors need a way to access your bloodstream. This is called dialysis access. The type of access you have can affect your health, quality of life, and even how well dialysis works.
A Case Story: Ramesh’s Experience
Ramesh, a 45-year-old man with kidney failure, started dialysis using a temporary catheter placed in his neck because his kidney disease had progressed quickly. He felt better after dialysis, but since he didn’t get an AV fistula created in time, the catheter stayed in place for many months.
After a few months, he developed fever and chills during dialysis. Tests showed a catheter-related blood infection. He needed hospitalization, antibiotics, and catheter removal. His doctor explained that if he had undergone an AV fistula surgery earlier, this complication could have been avoided.
Types of Dialysis Access
1.
Temporary Catheter (Double-lumen catheter)
- A plastic tube inserted into a large vein (usually in the neck or groin).
- Used when dialysis needs to be started urgently.
Positives:
Quick to insert
Useful in emergencies
Negatives:
✘ High risk of infection
✘ Can cause vein narrowing or clotting
✘ Not suitable for long-term use
2.
Tunneled / Permanent Catheter
- Similar to a temporary catheter but placed under the skin tunnel for longer use.
- Usually put in the chest vein.
Positives:
Can be used for longer periods than temporary catheter
No need for repeated needle pricks
Negatives:
✘ Still carries risk of infection
✘ May block veins, making fistula creation harder later
✘ Dialysis quality may not be as good as with a fistula
3.
AV Fistula (Arteriovenous Fistula)
- A surgeon connects an artery to a vein, usually in the arm.
- After a few weeks, the vein becomes strong enough to use for dialysis.
Positives:
Best and safest long-term access
Lowest risk of infection
Lasts for many years if cared for properly
Gives best blood flow for effective dialysis
Negatives:
✘ Takes 6–8 weeks to mature before use
✘ Requires minor surgery
✘ May not be possible in patients with weak veins
4.
AV Graft
- A synthetic tube connects an artery and vein when patient’s veins are not suitable for fistula.
Positives:
Can be used sooner than a fistula (2–3 weeks)
Option when veins are too small
Negatives:
✘ Higher infection risk than fistula
✘ May clot or block more often
✘ Usually lasts shorter than a fistula
Why is an AV Fistula Important?
- It is the gold standard access for hemodialysis worldwide.
- Has the lowest infection rate compared to catheters.
- Provides better dialysis efficiency, meaning cleaner blood and fewer complications.
- Lasts longer, reducing need for repeated procedures.
That’s why nephrologists always advise patients with chronic kidney disease (CKD) to plan for a fistula early, even before dialysis becomes necessary.
Transplant: The Best Long-Term Option
While dialysis is life-saving, it cannot fully replace the natural kidney. A kidney transplant is the best treatment for most patients with kidney failure, especially younger individuals. It offers:
- Better quality of life
- More freedom from hospital visits
- Longer survival compared to dialysis
But until a transplant is possible, the right dialysis access—preferably an AV fistula—makes dialysis safer and more effective.
Take-Home Messages
- Temporary catheters are for emergencies only. Keeping them long-term increases risk of infection.
- Tunneled catheters are safer than temporary ones but still not ideal for long-term.
- AV fistula is the best access for long-term dialysis—safe, durable, effective.
- AV graft is a good option when veins are not suitable.
- Plan early: If you have CKD, talk to your doctor about fistula surgery before dialysis becomes urgent.
- Transplant is the best solution for kidney failure, but until then, good dialysis access is your lifeline.
Just like Ramesh, many patients learn the hard way that delaying a fistula can cause avoidable complications. Early planning makes the journey smoother and safer.