Preferred Vascular Access — ESENeph MCQ

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EasyHaemodialysisPreferred Vascular AccessESENeph

A 72-year-old woman with CKD G5 (eGFR 8 mL/min/1.73m2) is symptomatic with nausea, fatigue, and fluid overload. She opts for haemodialysis. She has never had any central venous catheters. According to UKKA, what is the preferred vascular access?

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Correct answer: C — Radiocephalic (wrist) AV fistula

UKKA vascular access guidelines recommend native arteriovenous fistula (AVF) as the preferred primary access for haemodialysis. The radiocephalic (wrist) fistula is preferred first (preserves proximal vessels for future access). If wrist vessels are unsuitable, brachiocephalic or brachiobasilic fistula should be attempted. AV grafts are second-choice when native fistula is not possible. Tunnelled catheters should be avoided as primary access when possible. However, given she needs dialysis now and has no fistula, she will likely need a temporary tunnelled line while the fistula matures.

Reference: UK Kidney Association 2019 – Vascular Access Guideline