Dialysis and Vascular Access

The kidneys perform functions essential to sustaining life. They continuously clean the blood, flushing out impurities and balancing body chemistry. They also help regulate both blood pressure and the quantity of fluid leaving the body.

In the event that the kidneys fail, either at the final stage of chronic kidney disease (called end stage renal disease or ESRD) or as the result of an acute kidney injury, there are two options to take on the work of the non-functioning kidneys—dialysis, a group of alternatives to cleanse the blood outside of the kidneys, or the transplantation of a healthy kidney into the body.

Types of Dialysis

Hemodialysis accesses the bloodstream through a connection between an artery and a vein, called a vascular access. Blood circulates between that connection and a machine outside of the body to clean the blood. Ongoing hemodialysis can be performed at either an outpatient dialysis center or in an individual’s home, as well as in an inpatient setting if the patient is hospitalized for any reason (visit our Emergency and Hospital-Based Dialysis page for more information).

Peritoneal dialysis circulates a cleaning solution into the lining of the abdomen (called the peritoneum) to clean the blood. The peritoneum is accessed through a catheter in the abdomen.

Establishing and Maintaining Vascular Access

Establishing Access

Patients new to hemodialysis must undergo a surgical procedure (usually performed as an outpatient) to establish one of three types of vascular access:

  • Arteriovenous (AV) fistula: A direct connection between an artery and a vein, usually established on the surface of the arm.
  • Arteriovenous (AV) graft: A similar connection using a Gortex-like material to join the artery and vein.
  • Tunneled (subcutaneous) catheter: A connection made through a tube inserted beneath the skin.

New peritoneal dialysis patients must also have access established through a procedure that implants a soft catheter in the abdomen in order to access the peritoneal cavity used to perform the peritoneal dialysis

For patients hospitalized with acute kidney injury, emergency temporary vascular access can also be established using a venous catheter until a permanent access point can be established.

Maintaining Access

Over time, issues can arise at the point of access requiring prompt, skilled medical attention.  Fistula and graft access points can become clotted or fail. Peritoneal dialysis patients may develop problems if their abdominal catheters develop holes or become malpositioned.

Interventional Nephrology Unit (INU)

The INU is dedicated to providing excellent and timely care to chronic kidney disease and dialysis patients for both vascular access and peritoneal access needs. In addition to well-trained interventional nephrologists, the team is comprised of registered nurses, radiology technicians, access coordinators, as well as a host of other collaborating physicians. The INU offers cutting edge, innovative dialysis access placement and management strategies, as well as coordinated access care to meet the needs for hemodialysis and peritoneal dialysis patients.

The Interventional Nephrology Unit (INU) is located adjacent to the Acute Dialysis Unit on the 7th floor of University Hospital.

We offer the following services:

  • insertion and removal of tunneled hemodialysis catheters
  • insertion and removal of peritoneal dialysis catheters
  • fibrin sheath removal from chronically indwelling central catheters
  • mechanical thrombectomies of clotted hemodialysis catheters
  • angiograms
  • angioplasties
  • mechanical thrombectomies of clotted AVFs and AVGs
  • diagnostic sonography
  • renal biopsies
  • accessory vein ligation
  • peritoneal dialysis catheter insertion/manipulation
  • endovascular fistula creation
  • Dialysis access clinical trials

In addition, we provide world renowned training and education via Interventional Nephrology Fellowship program. 

At Michigan Medicine, we strive to provide superior dialysis access care for patients with end stage renal disease. After hours, including nights and weekends, routine messages and referrals may be communicated via voicemail or fax, and the dialysis access coordinators will respond the following business day. Urgent and emergent issues after hours are triaged via M-Line (800) 962-3555.

Hours of Operation: Monday – Friday 7:00 A.M. – 5:00 P.M.
Phone: (734) 936-5646
Fax: (734) 763-3016
After hours emergent issues: M-Line (800) 962-3555 

Email: [email protected]