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Time to Step Up to the Plate

Marcello Tonelli, MD, SM, FRCPC

JAMA. 2008;299(18):2205-2207.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Hemodialysis requires a reliable conduit to transport blood from the patient to the dialysis apparatus and back again, which is usually termed "vascular access." Establishing and maintaining vascular access is time-consuming, difficult, and expensive—access creation and complications are the most common causes of hospital admissions in patients with end-stage renal disease,¹ at an estimated annual cost of more than $1 billion in the United States alone.² Accordingly, vascular access has been termed the "Achilles' heel" of hemodialysis.³

Current options for vascular access include central venous catheters, synthetic grafts, and native vessel arteriovenous fistulas. Once established, arteriovenous fistulas are associated with the best clinical outcomes and the lowest costs.^4-10 However, unlike catheters and grafts, a substantial proportion of arteriovenous fistulas never mature sufficiently to be used for hemodialysis treatment, which is a major barrier to increasing the prevalence of their use. Although failure of arteriovenous fistulas . . . [Full Text of this Article]

Author Affiliations: Alberta Kidney Disease Network and Department of Critical Care, University of Alberta, Edmonton, and Institute of Health Economics, Edmonton, Alberta, Canada.

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JAMA. 2008;299(18):2164-2171.
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