Choosing Your Dialysis Access: 10 Common Questions

Hemodialysis needs a route for blood to leave the body and return from the machine. That route is the access. A catheter can be used right away, so it suits emergencies and the time in between. But the tube sits directly in a central vein, and the risk of infection is higher. In UK national registry data, Staphylococcus aureus bloodstream infection occurred in about 5.7% of catheter patients per year, against about 1.3% with a fistula. This is why international guidelines suggest moving to your own vessels as soon as conditions allow.

A fistula joins your own artery to your own vein. It is less likely to clot and has a lower infection rate, but it needs time to mature before use, anywhere from six weeks to six months. A graft connects the artery and vein with synthetic material, so it does not need to mature and can usually be used in three to four weeks; early-cannulation grafts are ready sooner. Grafts are somewhat more likely to clot or become infected, so regular follow-up matters.

You do not need to wait until dialysis starts. If you have chronic kidney disease stage 4 or 5 and may need dialysis within a year, it is reasonable to see a vascular surgeon now. In the meantime, protect the arm that may be used: avoid blood draws, IV lines and PICC lines on that side.

The doctor takes a history, examines you, and uses vascular ultrasound to look at the size, depth and quality of the arm’s arteries and veins. Age, daily activity level, peripheral artery disease, and any earlier access surgery on the same arm are also taken into account.

Usually six weeks to six months, depending on the quality of the vessel. While waiting, hand-ball exercise can help. If the vessel is maturing slowly, the doctor may also use a balloon to help it along. Until it is ready, dialysis generally continues through a catheter.

Maturation is related to age, sex, daily activity level, peripheral artery disease, the location of the fistula and earlier surgery on the same arm; the size of the vein and calcification of the artery matter too. A 2025 study from Singapore turned these factors into a score to estimate, before surgery, whether a fistula will be usable within three months. It is a reference before surgery and cannot promise the result for any one patient.

A double-lumen catheter has no cuff and carries a higher infection risk, so it should come out as early as possible. A tunneled cuffed catheter has a cuff and a lower infection risk; it can serve for the short to medium term, but it is still best to complete a long-term access soon and then remove it. How long it stays depends on the individual.

Dialysis is either peritoneal or hemodialysis. A peritoneal dialysis tube sits in the abdomen. Hemodialysis access comes in three kinds: a short-term catheter for emergencies, a tunneled cuffed catheter for longer use, and a fistula or graft for the long term.

EndoAVF joins the artery and vein from inside the vessel with a catheter, without surgical stitches. It is not currently used in Taiwan. Whether it would suit someone depends on a detailed ultrasound map of the arm vessels and the vessel condition. Reports from abroad also note that these fistulas often need close follow-up and sometimes a balloon adjustment before they can be used for dialysis.

That depends on your vessels, other medical conditions and how convenient care is for you; please decide with your nephrologist and vascular surgeon. A US retrospective study compared fistula creation at different sites, but patients were not randomized and the study took place in the US health system, so it cannot be applied directly to Taiwan.