Dialysis Access Visalia CA

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for simple and complex dialysis access cases!

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What is Dialysis Access?

Dialysis works by removing toxic substances from your blood. To do this effectively, a special channel must be created between your body and the dialysis machine to safely facilitate the exchange of fluids. This is where dialysis access comes in.

As the name suggests, dialysis access is the creation of an entry point between the dialysis machine and your body. This sounds simple enough, but effective dialysis requires careful manipulation of your vascular anatomy that is best left to a Vascular Specialist.

VIP Specialists dialysis access Visalia, CA

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About dialysis
Types of dialysis access
How do different dialysis access options compare?
Which dialysis access approach is right for me?

VIP: Your Dialysis Access Center in Visalia, CA

We are VIP Specialists, and we’re to help you smoothly transition into routine dialysis. Our Vascular and Interventional Specialists provide a full suite of screening and interventional services for all types of dialysis access. We’re a reliable partner for AV fistulas, AV grafts, intravenous, endovascular, and peritoneal access.

Our dialysis access center is conveniently located in downtown Visalia, California at the corner of Locust Street and East Acequia Avenue. Schedule your visit today!

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More about our Vascular Physicians
More about our location

Dr. Ashkan Shahkarami

Vascular & Interventional Specialist

Dr. Bennett K. Abe

Vascular & Interventional Specialist

Dialysis access specialist Dr. Bennett K. Abe in Visalia, CA

Dr. Francisco E. Valles

Vascular & Interventional Specialist

Dialysis access specialist Dr. Francisco E. Valles in Visalia, CA

Dr. Glade Roper

Vascular & Interventional Specialist

Dialysis access specialist Dr. Glade Roper in Visalia, CA

Dr. Daniel Hightower

Vascular & Interventional Specialist

Dialysis access specialist Dr. Daniel Hightower in Visalia, CA

What is Dialysis?

Dialysis is a treatment for severe kidney disease. With healthy kidneys, the toxins that naturally accumulate in the blood are filtered out into urine. As kidneys develop disease, they are unable to filter out enough toxins. This causes dangerous amounts of toxins in the body that can lead to serious illness and even death. Dialysis solves this dangerous problem by helping to filter toxins out of the blood and removing them from the body. [1]

Dialysis can either work outside the body via hemodialysis or inside the body via peritoneal dialysis. In either case, the goal of dialysis is to clean the blood often: 3-5x per week for hemodialysis or 3-5x per day for peritoneal dialysis. [2]

Hemodialysis – blood is directly withdrawn from the body. This blood is cleaned in a dialysis machine before being replaced back into the body.

Peritoneal dialysis – fluid is injected into the open cavity of the abdomen known as the “peritoneum.” This fluid stays in the cavity for multiple hours while slowly drawing toxins out of the blood, after which, the fluid and toxins are removed.

Do I Need Dialysis?

To determine if you require dialysis, your doctor can measure kidney performance and look for symptoms that indicate too many toxins. Blood and urine tests estimate kidney performance via glomerular filtration rate and albuminuria concentration. [3] Doctors also look for volume overload, severe potassium levels, and symptoms consistent with uremia. [3] Kidney performance may decrease gradually and predictably or very quickly.

At some point, you and your doctor will explore the treatment options of kidney transplant, dialysis, and conservative management. [4] If dialysis is selected or necessary until transplant can happen, you will choose between hemodialysis or peritoneal dialysis. When possible, doctors will plan the corresponding dialysis access procedure weeks to months before starting dialysis treatments. [5]

Diagram of hemodialysis vs. peritoneal dialysis to compare dialysis access methods

Hemodialysis (left) is done via the forearm vs. peritoneal dialysis (right), which is done via the abdomen.

Dialysis Access in Visalia, CA

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Types of Dialysis Access

Hemodialysis Access Methods

Arteriovenous Fistula

The most common access approach for hemodialysis is the creation of an arteriovenous fistula, also called AV fistula. To create an AV fistula, a neighboring artery and vein in the forearm are stitched together to form a loop that allows blood to safely flow through at a high rate. [7] The procedure permanently allows arterial blood to flow directly into a vein. This option is usually the safest and most robust approach to dialysis access, but it requires large and healthy veins, and therefore is not always feasible. [9]

Arteriovenous Graft

A similar option to the AV fistula is the arteriovenous graft, also called an AV graft. The graft option connects an artery to a special tube which then connects to a vein. This tube is placed under the skin, and the dialysis machine is connected directly into the special tube. The graft option is not quite as robust or as safe as a fistula, but it’s a great option for patients that don’t meet the anatomical requirements for fistula. [9]

Intravenous Hemodialysis Access

The third option is intravenous hemodialysis access, where a temporary tube is fed through a large vein and positioned near the heart. Outside the body, the other end of the tube splits into two smaller ends. One end moves blood from the body to the hemodialysis machine. The other end receives filtered blood and returns it to the body. The intravenous option allows dialysis treatment immediately, while the graft and fistula options can require several days or weeks after surgery before starting hemodialysis. However, the intravenous option should not be used for many dialysis treatments because the infection and complication rates are much higher [9].

Endovascular Access

The fourth option is endovascular access. In short, the procedure makes a fistula through minimally invasive devices. This option is very promising and very new, so researchers are still working to understand how it compares to the other options.

Peritoneal Dialysis Access Methods

There is only one access option available for peritoneal dialysis. This approach involves the permanent placement of a plastic or rubber tube through the abdominal wall and into the peritoneum cavity. [8] This port allows fluid to move in and out of the body.

Arteriovenous (AV) fistula created to support dialysis.

Arteriovenous (AV) fistula created to support dialysis.

Arteriovenous (AV) graft implanted to support dialysis.

Arteriovenous (AV) graft implanted to support dialysis.

Central venous catheter placed for intravenous hemodialysis.

Central venous catheter placed for intravenous hemodialysis.

Dialysis Access in Visalia, CA

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How Do Different Dialysis Access Options Compare?

Recent clinical studies have confirmed that hemodialysis and peritoneal dialysis are equally effective when it comes to patient survival. [11] Still, there are a few considerations that may cause you and your physician to choose a particular dialysis access approach over others.

Timeliness – You and your doctor should consider how soon you need dialysis. If you need immediate treatment, intravenous access may be your only option. In contrast, graft access usually requires 2 to 3 weeks after surgery before proper dialysis can begin, and fistula often requires 2 to 3 months. However, there are new methods that might allow shorter delay until dialysis. [10]

Risk of Infection – Infection rates vary significantly across these options. Fistula access has the lowest chance of infection, while graft access leads to infection nearly twice as often, and intravenous access causes nearly three times as many infections as fistula. [12]

Patient undergoing dialysis after VIP Specialists dialysis access procedure in Visalia, CA

Patient being prepped for a hemodialysis session.

Risk of Closure – There’s a chance that your dialysis access site can become blocked over time. Fistulas and grafts tend to stay open longer than other access options, with fistulas being the most likely to stay open for 3 years or longer. [13] To keep a dialysis access site open and working, patients can receive blood thinners, balloon procedures, stent placements, and clot removal. [9]

Which dialysis access approach is right for me?

You and your doctor should work together to determine which dialysis access option will best serve your situation. If you need immediate dialysis, you will likely start with an intravenous option. If you can wait a few days or months, you can decide if peritoneal dialysis or hemodialysis fits your life best. If you want to pursue hemodialysis, a clinician will scan your blood vessels to determine fistula and graft options. [14] Depending on the results and your health aspirations, you will finally receive an access site that you and your healthcare team will use and care for moving forward.

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References
[1] Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The Lancet, 379(9811), 165–180.
[2] Slinin, Y., Greer, N., Ishani, A., MacDonald, R., Olson, C., Rutks, I., & Wilt, T. J. (2015). Timing of Dialysis Initiation, Duration and Frequency of Hemodialysis Sessions, and Membrane Flux: A Systematic Review for a KDOQI Clinical Practice Guideline. American Journal of Kidney Diseases, 66(5), 823–836.
[3] Rivara, M. B., & Mehrotra, R. (2017). Timing of Dialysis Initiation: What Has Changed Since IDEAL? Seminars in Nephrology, 37(2), 181–193.
[4] Wong S. P. Y., McFarland L. V., Liu C-F., … O’Hare A. M. (2019). Care Practices for Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis. JAMA Internal Medicine, 179(3):305-313.
[5] Kukita, K., Ohira, S., Amano, I., Naito, H., Azuma, N., … Ikeda, K. (2015). 2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis. Therapeutic Apheresis and Dialysis, 19, 1–39.
[6] Balraj, P.C., Hodari-Gupta, A., Haddad, G., (2017). Endovascular and Open Vascular Reconstruction: A Practical Approach, 365-370.
[7] Pisoni, R. L., Zepel, L., Port, F. K., & Robinson, B. M. (2015). Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons. American Journal of Kidney Diseases, 65(6), 905–915.
[8] Chaudhary, K., Sangha, H., & Khanna, R. (2010). Peritoneal Dialysis First: Rationale. Clinical Journal of the American Society of Nephrology, 6(2), 447–456.
[9] Schmidli, J., Widmer, M. K., Basile, C., de Donato, G., Gallieni, M., Gibbons, C. P., … Roca-Tey, R. (2018). Editor’s Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery, 55(6), 757–818.
[10] Xue, H., Ix, J. H., Wang, W., Brunelli, S. M., Lazarus, M., Hakim, R., & Lacson, E. (2013). Hemodialysis Access Usage Patterns in the Incident Dialysis Year and Associated Catheter-Related Complications. American Journal of Kidney Diseases, 61(1), 123–130.
[11] Wong, B., Ravani, P., Oliver, M. J., Holroyd-Leduc, J., Venturato, L., Garg, A. X., & Quinn, R. R. (2018). Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities. American Journal of Kidney Diseases, 71(3), 344–351.
[12] Ravani, P., Gillespie, B. W., Quinn, R. R., MacRae, J., Manns, B., Mendelssohn, D., … Pisoni, R. (2013). Temporal Risk Profile for Infectious and Noninfectious Complications of Hemodialysis Access. Journal of the American Society of Nephrology, 24(10), 1668–1677.
[13] Murad, M. H., Elamin, M. B., Sidawy, A. N., Malaga, G., Rizvi, A. Z., Flynn, D. N., … Montori, V. M. (2008). Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis. Journal of Vascular Surgery, 48(5), S34–S47.
[14] Murphy, E. A., Ross, R. A., Jones, R. G., Gandy, S. J., Aristokleous, N., Salsano, M., … Houston, J. G. (2017). Imaging in Vascular Access. Cardiovascular Engineering and Technology, 8(3), 255–272.

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The Materials available on visaliavips.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.