Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Vascular Access Considerations for Patients on Home Hemodialysis

Video Transcription

Video Summary

Dr. Annie-Claire Naudot-Fredette reviews vascular access choices for home hemodialysis (HHD): central venous catheters (CVCs), arteriovenous fistulas (AVFs), and grafts. While AVFs offer best long-term patency and flow, they require maturation and can be harder to cannulate; grafts mature faster but carry higher infection/thrombosis risk; CVCs are easiest and speed HHD start but have higher infection/thrombosis risk and are associated (in registries) with higher mortality, hospitalization, and transfer back to in-center dialysis.<br /><br />HHD adds unique issues: more frequent/longer treatments, self-cannulation, and safety in an unsupervised home setting. Rope-ladder cannulation is generally preferred. Buttonhole cannulation may help when fistulas are short, tortuous, aneurysmal, or when self-cannulation is otherwise difficult, but multiple studies show higher infection rates with buttonhole and little clear evidence of less pain. If used, strict asepsis, careful tract creation, blunt needles after tract formation, and topical antibiotic prophylaxis are emphasized.<br /><br />Bleeding/disconnection prevention requires intensive training, secure taping, wetness/blood detectors, and clear emergency protocols. Monitoring for dysfunction (pressures, prolonged bleeding, cannulation difficulty) and periodic flow studies/ultrasound are recommended.<br /><br />She stresses patient-centered “vascular life plans”: HHD can be done safely with any access type if supported by strong training, protocols, and auditing.

Asset Subtitle

Annie-Claire Nadeau-Fredette

Meta Tag

Module DIAL

Speaker Annie-Claire Nadeau-Fredette

Keywords

home hemodialysis

vascular access

arteriovenous fistula (AVF)

central venous catheter (CVC)

arteriovenous graft

buttonhole cannulation

infection and thrombosis risk