Medically Reviewed by David S. Bjerken, MD, FACS

When a person has kidney problems, they turn to a nephrologist, a specialist in treating diseases of the kidney. Yet, patients with kidney problems often require dialysis and for that the Vascular Specialist plays a key role.

Here are the highlights of Dr. Bjerken’s comments:

Evidence of kidney failure is increasing in our population. More and more often someone finds they need to consider dialysis.

Dialysis can be accomplished in the form of a transplant. That’s perhaps an ideal answer. It also is accomplished with what is called hemodialysis, dialyzing the blood. Then there’s what we call peritoneal dialysis, which is instilling fluid in the abdominal cavity and filtering out the impurities.

The most common form of dialysis is hemodialysis and it requires access to the blood stream to be accomplished.

How do we establish access for someone who’s going to be on hemodialysis? There are three ways. A catheter might be placed in the large veins of the neck, allowing the patient to be connected to the dialysis machine. Then, there is what we call a fistula. A fistula is where we connect a person’s vein in their arm to one of their arteries. The third form is a graft, where material or tubing is implanted under the skin in the arm, connecting one end to a vein and the other end to an artery.

Of the three options, a fistula is preferred because it’s more long lasting. A graft would be the second choice. They tend to work more quickly but commonly have problems after some use. Finally, there’s a catheter, which many people have in the early stages. It’s really more of a temporary means and not a permanent form of access.

Once a person has either a graft, fistula or catheter, they go to a dialysis center three times a week. With a fistula, the technicians at the dialysis unit put a needle into their vein through the skin. One needle lets the blood out. Then it is dialyzed or processed through the machine. A second needle in the arm allows return of the blood flow. The dialysis is allowing the blood to be brought out through the machine and then back into the body. Dialysis treatments each usually take three hours, sometimes four hours, depending on the quality of the fistula and how the flow is accomplished.

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