| Abstract: |
For the nephrologists and surgeon, maintaining vascular access is a significant challenge in hemodialysis (HD), because the portal is vulnerable to infection, stenosis, and thrombus. Vascular access options for HD include the placement of arteriovenous (AV) fistulas, AV grafts, and double-lumen, cuffed central vein catheters. Catheter use is generally associated with higher rates of infection and could compromise the adequacy of HD. Primary AV fistulas, which are generally recommended and provide excellent HD access, are not always the ideal choice for certain patients, such as the elderly or patients with diabetes mellitus .AV grafts allow for a large surface area available for cannulation, and thrombosed grafts have longer patency rates after revision than do revised fistulas. Although both AV fistulas and AV grafts are vulnerable to thrombosis and/ or stenosis, surveillance and techniques such as Doppler ultrasound and intravascular ultrasound can minimize such complications. In addition, pharmacotherapeutic options are being studied to determine whether these complications can be prevented.DM is an important risk factor for the incidence of infection. Other risk factors for dialysis CRBSI include older age, higher total intravenous iron dose, increased recombinant human erythropoietin dose, lower hemoglobin level lower serum albumin level diabetes mellitus, peripheral atherosclerosis, and recent hospitalization or surgery.
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