Hemodialysis Access in North America

End Stage Renal Disease (ESRD) is a devastating disease affecting the health of many people world-wide. The primary goal of therapy for patients with ESRD is to maintain health throughout their life. The most effective therapy for ESRD is renal transplantation. Alternatively there are two modes of renal replacement therapy (RRT), peritoneal and hemodialysis. Peritoneal dialysis can be an excellent option for patients who have not undergone major abdominal operations, but does require wherewithal to perform peritoneal dialysis nightly. In North America many vascular surgeons do not perform placement of peritoneal dialysis catheters and as such this chapter will focus on hemodialysis.