Hemodialysis remains the primary modality of renal replacement therapy for patients reaching end-stage renal disease (ESRD). The patient’s vascular access provides the conduit that allows for successful delivery of dialysis therapy. Thus, the vascular access is truly the “lifeline” for the hemodialysis patient. There are three primary types of vascular access a hemodialysis patient can utilize for dialysis therapy: (1) arteriovenous fistula, (2) arteriovenous graft, and (3) tunneled hemodialysis catheter. Each type of vascular access provides distinct advantages and disadvantages. The ideal vascular access would be useable soon after creation with low maturation failure rates and have infrequent mechanical and infectious complications. However, the ideal vascular access does not currently exist. Thus, appropriate vascular access selection, maintenance of vascular access, and development of therapies to treat vascular access dysfunction remain critical to improving morbidity and mortality for hemodialysis patients.
