Trials and trade-offs in haemodialysis vascular access monitoring

monitoring; thrombosis There are currently more than 300 000 patients receiving haemodialysis in the US and similar numbers are estimated in Europe. Despite the recognition that vascular access is the ‘Achilles heel ’ of the dialysis procedure, haemodialysis vascular access failure and related complications continue to be one of the most difficult obstacles in the optimal care of dialysis patients. In the US, haemodialysis vascular access procedures and complications account for more than 20 % of hospitalizations of haemodialysis patients and result in more than $1 billion per year of government paid expenditures [1]. Additional, often unrecognized costs stem from missed treatments, the placement and use of dialysis catheters and the significant inconvenience and anxiety endured by the patients. There have been several initiatives to improve vascular access survival, including publication of several clinical practice guidelines (such as the Kidney Disease Outcome Quality Initiative, or KDOQI) and the Fistula First initiative, spawned by the Centers fo