Kidney Failure and Dialysis Access Kidneys

What is kidney (or renal) failure?
Renal failure occurs when the kidneys stop working and a person's only chance of survival is dialysis treatment, which takes over the waste-removal and chemical-balancing work of the original kidneys. Without a kidney transplant renal failure is permanent–with no cure.

What causes kidney failure?
Kidney failure can be acute–in other words, sudden. Or it can be the result of chronic kidney disease, which is an ongoing condition that does its damage over time. Each condition has different causes.

  • Causes of acute kidney failure: Prerenal failure is the most common type of acute kidney failure. Over a brief period, the kidneys stop receiving enough blood to filter. Causes include: blockage/atherosclerosis; dehydration (from vomiting, diarrhea, water pills or blood loss); or disruption of blood flow to the kidneys for various reasons. Postrenal failure is the rarest form of acute kidney failure, and is usually caused by something blocking the elimination of urine produced by the kidneys, for example, a kidney stone or enlarged prostate.

  • Causes of chronic kidney disease: This umbrella term includes conditions that damage the kidneys. Causes include diabetes, high blood pressure, and a family history of kidney disease. The disease often progresses slowly, but can eventually lead to kidney failure.

What happens during dialysis treatment?
Dialysis is a life-saving procedure that cleans the blood of toxins, removes excess fluid from the body, and performs other vital kidney functions. A patient is connected to a dialysis machine that works like an artificial kidney connected through a graft, fistula or catheter placed in the body. That connection is called dialysis access, because it gives the filtering equipment entry–or access–to the person's bloodstream.

How is dialysis access created?
There are several ways to connect a person's vascular system to dialysis equipment. Each requires only a minor surgical procedure.

  • For short term and immediate access:
    • Catheter: a long soft tube is inserted in the large vein either in the neck or under the collar bone.
  • For long term access:
    • Arterivenous graft: a man-made tube called a graft is inserted under the skin to connect an artery to a vein.
    • Arterivenous fistula: a surgically created passage in which an artery is directly connected to a vein.
    • Peritoneal dialysis (PD) may be used where a catheter is surgically inserted into the abdomen on a permanent basis.

The vascular surgeons at Beth Israel routinely treat patients who require dialysis access.

For An Appointment Call

Robert J. Grossi, MD
Vascular Surgery

Gary A. Gwertzman, MD
Vascular Surgery and Wound Care

Stephen P. Haveson, MD
Vascular Surgery and Wound Care

Daniel Han, MD
Vascular Surgery

Vascular Labs