If your kidneys fail, unless and until you have a successful kidney transplant, you will need dialysis therapy to clean and filter your blood. The first step is establishing dialysis access one of four ways:

• A tunneled catheter in your neck—temporary, because the possibility of infection and vein damage is high.
• An AV fistula—sewing a vein from your arm into a nearby artery, and allowing the sewn-in vein to enlarge and become thicker, like an artery. Considered the best option because it lasts the longest and has the lowest risk of infection.
• An AV graft—the sewing of a prosthetic graft between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.
• Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day. This is a convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.

Why It's Done

When your kidneys fail, your body is unable to clean and filter your blood. Electrolyte levels, such as potassium and phosphorous, can become dangerously high. Your body also may not get rid of fluid resulting in heart failure and difficulty breathing. When kidney function falls below a certain threshold dialysis is needed.

Risks

Bleeding is the most common complication. Generally, this is noticed and taken care of before you go home.

Contact your dialysis access surgeon immediately if...

• You notice swelling or a saturated dressing.
• Your hand or leg becomes very cold or numb as this may indicate a serious problem (“steal syndrome”) that may need urgent attention. This occurs when the AV access works too well and steals blood from the hand.

Slight coolness in the affected hand or leg is common. This happens because some of the blood that was supplying the hand or leg is being redirected. Squeezing an old tennis ball or racquetball in your hand can help your body re-adjust.

Vibration changes are normal. When you place your hand over the fistula or graft, you should feel a vibration. If the vibration stops or becomes a pulsation, contact your dialysis access surgeon as the changes may indicate that the access has narrowed.