title: Dialysis access: an increasingly important clinical issue.
abstract: Dialysis access, including vascular access for hemodialysis and peritoneal access for peritoneal dialysis, is critical in the clinical care of patients with end-stage renal disease. It is associated with increases in morbidity, mortality, and health care costs. A number of problematic issues are involved, some of which are addressed in this paper with reference to the most recent publications, including: the inappropriately low prevalence of peritoneal dialysis in Western countries, which is relevant to access placement in the pre-dialysis stage; the excessively high use of central venous catheters in incident and prevalent dialysis patients; the diagnosis and treatment of steal syndrome; the advantages and limitations of antiplatelet therapy; and finally, the correct pre-operative evaluation and subsequent surveillance of the vascular access.
authors.affiliation: Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy. gallieni.maurizio@sancarlo.mi.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Alma
authors.initials: A
authors.lastname: Martini
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Mezzina
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003952:Diagnostic Imaging; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology; D019983:Guideline Adherence; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010530:Peritoneal Dialysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D010975:Platelet Aggregation Inhibitors