There are nearly half a million-people requiring hemodialysis with approximately 100,000 new cases of end-stage renal disease (ESRD) on an annual basis. There are multiple types of arteriovenous (AV) hemodialysis access. In 2003, the Centers for Medicare and Medicaid Services (CMS) and the ESRD networks developed an initiative called the Fistula First Initiative. The results of this program aimed at to reduce the increasing cost burden of hemodialysis frequently associated with complications secondary to access. Of the types of AV access, an autogenous AV access has higher patency rates and low risk of complications when compared with prosthetic arteriovenous accesses and lower risk of infection compared to temporary central venous catheters (CVC). The goals of the initiative were to raise the use of AV access at the initiation of dialysis. A thorough preoperative workup is imperative to establishing long-term hemodialysis access.
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