Tackling the Achilles' Heel of Hemodialysis

More than 375,000 patients undergo long-term hemodialysis treatment in the United States, but the outcomes have remained abysmal, with the rate of death during the first year of hemodialysis therapy exceeding 20%. Although the development half a century ago of techniques for sustainable vascular access rendered long-term extracorporeal treatment feasible, vascular access remains the Achilles' heel of hemodialysis. The current options include arteriovenous fistulas, synthetic grafts, and central venous catheters, with a clear hierarchy among these options. Native arteriovenous fistulas — simple anastomoses of forearm arteries and veins — yield the best outcomes. Among otherwise similar patients, those with functioning . . .