Dialysis Access Considerations for Patients Awaiting Kidney Transplantation

Patients facing end stage renal disease are often referred for surgical creation or placement of permanent dialysis access, and at the same time, referred for kidney transplant evaluation. In many instances, the surgical team performing dialysis access procedures is not aware of the patient’s journey with kidney transplantation. Herein we discuss a thoughtful approach to patients awaiting kidney transplant as it relates to their need for permanent dialysis access. We recommend a collaborative effort amongst the nephrologist, transplant team and dialysis access surgeon to generate a longitudinal renal replacement plan. This will avoid unnecessary dialysis access creation and may prevent futile utilization of access options that could be preserved for future use if/when a renal allograft fails. If a patient is likely to have a kidney transplant within 4–6 months or sooner, creation of permanent dialysis access should be avoided.