Vascular access for hemodialysis: A perpetual challenge

Semin Dial. 2019 Nov;32(6):527-534. doi: 10.1111/sdi.12828. Epub 2019 Jun 17.


Vascular access for hemodialysis has a long and rich history. This article highlights major innovations and milestones in the history of angioaccess for hemodialysis. Advances in achievement of lasting hemodialysis access, swift access transition, immediate and sustaining access to vascular space built the momentum at different turning points of access history and shaped the current practice of vascular access strategy. In the present era, absent of large-scale clinical trials to validate practice, the ever-changing demographic and comorbidity makeup of the dialysis population pushes against stereotypical angioaccess goals. The future of hemodialysis vascular access would benefit from proper randomized clinical trials and acclimatization to clinical contexts.

Keywords: arteriovenous access; central venous catheter; fistula; graft; hemodialysis.

Publication types

  • Review

MeSH terms

  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / physiopathology
  • Central Venous Catheters / statistics & numerical data*
  • Clinical Decision-Making
  • Female
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Male
  • Patient Selection*
  • Practice Patterns, Physicians' / trends
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods*
  • Risk Assessment
  • Vascular Access Devices / trends*