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Kidney and Pancreas Transplantation

Dialysis Access

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The Comprehensive Dialysis Access Center, a part of NewYork-Presbyterian Hospital/Weill Cornell Transplant Center offers patients dialysis access services in one setting. Our surgeons are trained in the latest operative and interventional techniques in order to treat patients with chronic kidney disease in a manner that preserves their dialysis access options into the future, and we support the National Kidney Foundation's 'Fistula First' Breakthrough Initiative. Special focus is placed on ensuring long-term maintenance of our patient's dialysis access. Patients are able to have their dialysis access needs met while they are simultaneously evaluated for kidney transplantation at one of the nation's leading kidney transplant programs.

Find out more about kidney dialysis.

About Dialysis

The job of the kidneys is to clean your blood of waste products and extra fluid. When your kidneys fail, you need dialysis to clean your blood since the kidneys are not working correctly. There are two options for dialysis:

  • Hemodialysis. Your blood is directly cleaned and filtered by a machine. Each dialysis treatment generally lasts 3 to 4 hours, and is usually performed three times a week.
  • Peritoneal dialysis. Your blood is cleaned indirectly by placing a concentrated sugar solution in your abdomen, which help to draw out the waste products and extra fluid from your body. The solution is then drained from your body several times per day.

Patient Receiving Hemodialysis Treatment

In order to clean your blood during hemodialysis, you need to have a site on your body that is used to remove your blood for cleaning and return the cleaned blood to your body. The site that is created to do this is called "vascular access". Vascular access sites allow a larger amount of blood to be cleaned during the dialysis treatment. For peritoneal dialysis, you will need a catheter (tube) placed in your abdomen which will allow you to place the sugar solution into your abdomen, and later to drain the fluid from your body. For either type of dialysis, the surgery to create your access is timed a few months before you are expected to need dialysis so that you can heal adequately before the access needs to be used.

What Are My Options for Dialysis Access?

There are three types of vascular access that can be created for you to be able to receive hemodialysis treatments and one type of access that can be created for peritoneal dialysis:

Vascular Access

Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Arteriovenous (AV) Fistula

A fistula is a connection made between blood vessels (an artery and vein) that causes the vein to grow larger and stronger and therefore a good site to use for accessing your bloodstream during dialysis. Because the vein needs to grow and become stronger, fistulas generally take 2 to 3 months before they can be used for dialysis.

Fistulas are the preferred type of vascular access because fistulas last longer and are less likely to have complications such as blood clots and infections.

Arteriovenous (AV) Graft

A graft is a synthetic material used to connect the artery and vein that serves as an artificial vein that can then be used as your hemodialysis access site. AV grafts are used less commonly than fistulas, however grafts are needed for some patients who have small veins.


Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Venous Catheter

A catheter is a tube placed into a vein in the neck, upper chest, or more rarely, the upper leg. Catheters are considered temporary vascular access because catheters are at higher risk for clots, infections, and may cause damage to your veins if used for a long period of time.
Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Peritoneal Dialysis (PD) Catheter

A peritoneal dialysis catheter is a tube placed into your abdominal cavity through a small incision near your belly button. The catheter can usually be used 2 weeks after surgery. The part of the tube on the inside of your body has many small holes that allow fluid (called dialysate) to move in and out.


Diagram of tenckhoff peritoneal catheters. Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health


Drawing of male patient during peritoneal dialysis exchange Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Dialysis Access Services

In order to best serve the needs of our patients, we offer a comprehensive range of services in order to create and maintain your dialysis access in the best way possible.

These services include:

  • Comprehensive evaluation visit to determine the best type of access for each individual patient
  • Creation of AV Fistulas
  • Creation of AV Grafts
  • Insertion of peritoneal dialysis catheters
  • Insertion of venous catheters
  • Diagnosis and management of vascular access complications such as clotting and infection
  • Diagnosis and management of peritoneal dialysis catheter complications

Contact

Kidney and Pancreas Transplantation
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(212) 746-3099
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