Author Affiliations: Veterans Administration Medical Center and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City.
More than 600 000 patients in the United States have end-stage kidney disease, with the majority—nearly 400 000 patients—requiring long-term maintenance hemodialysis.1 Ready access to the bloodstream is essential for hemodialysis and may be provided by a surgically created arteriovenous fistula, arteriovenous graft, or central venous catheter.2,3 An arteriovenous fistula is preferred because of its lower risk of thrombosis and lower overall cost. However, delayed maturation and failure rates of 20% to 60% for new fistulas result in greater reliance on catheters, the least desirable type of hemodialysis access.2,3 Compared with a new fistula, an arteriovenous graft is easier to cannulate and can be used within a few weeks of surgical creation. Yet grafts are associated with a higher rate of thrombosis, with attendant increased morbidity and cost. Grafts were once the most common type of hemodialysis access in the United States. However, through the efforts of the Fistula First Initiative, the End-Stage Renal Disease Networks, and the medical community, the prevalence of grafts in the United States has recently declined to less than 25%.4 Given the challenges of fistula maturation, grafts remain an appealing option, if the problem of thrombosis can be solved.
Dixon BS. Fish Oil and Hemodialysis Graft Patency: Does Time Matter? JAMA. 2012;307(17):1859–1860. doi:10.1001/jama.2012.4101
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