From the Guidelines
A dialysis shunt and a dialysis catheter are fundamentally different in terms of their structure, placement, and longevity, with the shunt, typically an arteriovenous (AV) fistula or graft, being preferred for long-term dialysis due to its lower infection rates and longer functional life, as supported by the most recent guidelines 1.
Key Differences
- A dialysis shunt, or AV fistula/graft, is a permanent access created surgically, offering better long-term outcomes with fewer infections and longer functional life.
- A dialysis catheter is a temporary access with higher infection rates, more clotting problems, and reduced blood flow efficiency, used in emergency situations or as a bridge until a permanent access matures.
Considerations for Choice
- The choice between a shunt and a catheter depends on the patient's vascular anatomy, expected duration of dialysis, and overall health status.
- AV fistulas are generally preferred for long-term dialysis patients due to their superior patency, lower complication rates, and association with increased survival and lower hospitalization rates, as noted in 1 and reinforced by more recent studies like 1.
Clinical Guidelines
- The KDOQI guidelines suggest that AV access (AVF or AVG) is preferable to a central venous catheter (CVC) for hemodialysis whenever possible, due to the association of AV access with reduced vascular access-related events 1.
- Tunneled dialysis catheters may be used for short-term or long-term durations under specific conditions, including when AV access is not feasible or as a bridge until AV access is ready for use, with considerations for patient preference and quality of life 1.
From the Research
Overview of Dialysis Shunt and Catheter
- A dialysis shunt, also known as an arteriovenous (AV) fistula, is a surgically created connection between an artery and a vein, typically used for long-term hemodialysis access 2.
- A dialysis catheter, on the other hand, is a tube inserted into a vein to provide temporary or permanent access for hemodialysis 3, 4.
Key Differences
- Surgical creation: A dialysis shunt requires surgical creation, whereas a dialysis catheter can be inserted without surgery 2, 3.
- Infection risk: Dialysis catheters are associated with a higher risk of infection compared to AV fistulas 2, 5.
- Long-term use: AV fistulas are generally preferred for long-term use due to their lower complication rates and longer patency rates 2, 5.
- Blood flow: Dialysis catheters can provide adequate blood flow for hemodialysis, but may be more prone to thrombosis and malfunction 3, 4.
Clinical Considerations
- Patient selection: The choice between a dialysis shunt and catheter depends on individual patient factors, such as vascular anatomy and medical history 5.
- Catheter management: Proper catheter management, including locking solutions and exit site care, can help prevent complications and extend catheter lifespan 3, 5.
- Interventional procedures: Catheter-based interventions can be used to restore flow in failing or thrombosed dialysis accesses, reducing the need for surgical revision 6.