Dialysis access infections

Infections and specifically infectious complications of vascular access rem ain a major cause of morbidity and mortality in the hemodialysis population , Primary arteriovenous fistulas have the lowest rates of infections and ar e the access of choice whenever vascular anatomy allows. The dialysis outco mes quality initiative (DOQI) guidelines have thus stressed the need for in creasing the utilization of arteriovenous fistulas, Unfortunately, comorbid disease processes and late referrals for vascular access have maintained o ur dependence on synthetic grafts and indwelling catheters. indwelling cath eters, in particular, have the highest rate of infection and are often asso ciated with more serious metastatic complications. Appropriate antibiotics along with aggressive surgical debridement remain crucial in bacteremia occ urring in arteriovenous fistulas or synthetic grafts (polytetrafluoroethyle ne). Catheter related bacteremia necessitates catheter removal with either guidewire exchange or replacement after a period of antibiotic therapy. Mea sures to increase our utilization of primary fistulas whenever possible wil l lower the risk of these complications in our patients. Curr Opin Nephrol Hypertens 9:631-635. (C) 2000 Lippincott Williams & Wilkins.