Shunt, Dialyseeinleitung, Katheter

The elective start of dialysis therapy via a well planned dialysis access requires early presentation at a nephrologist. Native fistulas, with their numerous modifications, are considerably superior to polytetrafluoroethylene (PTFE) grafts, both in terms of patient survival as well as infection and occlusion rates. Native fistulas should be placed at least 3 months and PTFE grafts 4 weeks prior the start of dialysis. If fistulas or PTFE grafts are not possible, or there are other contraindications such as severe heart insufficiency, dialysis should be started with a tunnelled catheter for vascular access. In Germany, dialysis is currently started at a mean GFR of 7.8 ml/min. Starting at <6 ml/min should definitely be avoided. In case of multimorbid patients, an earlier start may be necessary, exceptionally at a GFR >15 ml/min.