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.

Learn more about dialysis alternatives on our Patient Education website.

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.

Multidisciplinary Dialysis Access Center

The Multidisciplinary Dialysis Access Center 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 interventional nephrologists and surgeons, the team is comprised of registered nurses, radiology technicians, access coordinators, as well as a host of other collaborating physicians. Our Multidisciplinary Dialysis Access Clinic offers innovative dialysis access placement and management strategies, as well as coordinated access care for hemodialysis and peritoneal dialysis patients.

The dialysis access coordinators serve as a single triage point of contact for referring dialysis units and physicians to ensure patients are seen in a timely manner. The access coordinator expedites the development and implementation of the multidisciplinary plan of care. Using the resources available at Michigan Medicine, care may be provided to the most complex renal disease patients.

We offer the following services:

  • Arteriovenous fistula and graft creation and revision
  • Dialysis catheter placement and management
  • Fistulograms
  • Endovascular angioplasty or stent placement
  • Arteriovenous fistula or graft declot
  • Native and transplant renal biopsy
  • Venography
  • Peritoneal dialysis catheter placement and management
  • Infusion catheter placement and management
  • Dialysis access ultrasound
  • HeRO access placement and management
  • Integrated hand surgery
  • Dialysis access clinical trials

At Michigan Medicine, we strive to provide superior multidisciplinary 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.

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

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: Dialysis-Access-Coordinators@med.umich.edu