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Medically Reviewed By:

2026-07-01

  • Condition
  • Other
  • Severity: Routine

Chronic Kidney Disease / ESRD

Also Known As: ESRD, end-stage renal disease, renal failure, kidney failure requiring dialysis

What Is Chronic Kidney Disease?

Chronic kidney disease (CKD) is a condition in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. It develops slowly over time, often without noticeable symptoms in its early stages, and is most commonly caused by diabetes, high blood pressure, or chronic inflammation of the kidney tissue. As CKD progresses to its most advanced stage — end-stage renal disease (ESRD) — the kidneys can no longer sustain life on their own, and patients require either dialysis or a kidney transplant.

CKD affects an estimated 37 million adults in the United States, and Florida — with its large population of older adults and high rates of diabetes and hypertension — carries a significant share of that burden. For many patients in the Sarasota and Bradenton area managing CKD, the question of dialysis access becomes one of the most important decisions in their ongoing care.

Why Vascular Access Is Critical in CKD

Hemodialysis — the most common form of kidney replacement therapy — requires reliable, repeated access to a patient’s bloodstream, typically three times per week. The quality of that access directly affects the quality of dialysis and, by extension, the patient’s survival and quality of life. A well-functioning access site means efficient dialysis sessions, fewer complications, and less time in a dialysis center dealing with problems.

Vascular surgeons are the specialists responsible for creating and maintaining dialysis access. At Vascular Wellness Institute, our surgeons work closely with nephrologists throughout Manatee and Sarasota County to ensure that patients with CKD have an access plan in place before dialysis becomes urgent — because planning ahead almost always leads to better outcomes.

Types of Dialysis Access

Arteriovenous (AV) Fistula

An AV fistula is the preferred form of dialysis access for most patients. It is created surgically by connecting an artery and a vein — most commonly in the forearm or upper arm — causing the vein to enlarge and develop thicker walls over time. This creates a durable, high-flow access site that can be used for dialysis needles session after session. AV fistulas have the best long-term outcomes, the lowest infection rates, and the fewest complications of any access type. Because they require several weeks to mature before use, they should be placed well before dialysis becomes necessary — typically when a patient’s kidney function reaches a certain threshold, in coordination with their nephrologist.

Dialysis Access Maintenance

Arteriovenous (AV) Graft

When a patient’s veins are not suitable for a fistula — due to small size, prior damage, or other anatomical factors — an AV graft may be used instead. A graft is a synthetic tube that connects an artery to a vein, creating an artificial conduit for dialysis access. Grafts can be used sooner after placement than fistulas, making them an option when access is needed more urgently. They require more maintenance over time than fistulas but are a reliable choice for patients who are not fistula candidates.

Both fistulas and grafts require monitoring and, when problems arise, intervention to keep them functioning well. Common issues include stenosis (narrowing), thrombosis (clotting), and aneurysm formation. Vascular Wellness Institute performs a full range of access maintenance procedures — including fistulogram (imaging of the access), angioplasty (balloon dilation of narrowed segments), declotting, and stent placement when appropriate — to restore and preserve function.

Our Approach: Planning Ahead

The single most important thing a CKD patient can do for their dialysis future is plan early. Patients who arrive at dialysis with a maturing fistula already in place have significantly better outcomes than those who start dialysis through a temporary catheter. Catheters carry higher infection risk, lower dialysis efficiency, and are intended as a bridge — not a long-term solution.

At Vascular Wellness Institute, we work with your nephrologist to map your veins with ultrasound, assess the best access option for your anatomy, and create an access site at the right time. If you have CKD and have been told dialysis may be in your future, a consultation with our team is appropriate now — not when your kidney function deteriorates further.

SYMPTOMS

  • Common reasons patients are referred for dialysis access creation: eGFR approaching 20 mL/min/1.73m², anticipated dialysis start within 6–12 months, failed peritoneal dialysis, tunneled catheter complications

DIAGNOSIS METHODS

  • Vein Mapping Ultrasound +

    Pre-operative assessment of vein caliber, quality, and depth to identify the optimal vessels for AV fistula creation.

  • Serum Creatinine / eGFR +

    Confirms ESRD status and guides timing of access creation.

  • Nephrology Evaluation +

    Required prior to surgical referral — nephrology team coordinates timing with vascular surgery.

TREATMENTS

Please call either office to discuss dialysis access options.

RELATED CONDITIONS

None

FREQUENTLY ASKED QUESTIONS

  • When should a CKD patient see a vascular surgeon about dialysis access? +

    Most nephrologists recommend a vascular surgery consultation for dialysis access planning when a patient's estimated glomerular filtration rate (eGFR) falls below 20–25 mL/min/1.73m², or when dialysis is anticipated within the next 6–12 months. An AV fistula typically requires 6–12 weeks to mature before it can be used for dialysis, so early planning is essential. If your nephrologist has mentioned dialysis as a possibility, ask for a referral to a vascular surgeon sooner rather than later.

  • What is the difference between an AV fistula and an AV graft? +

    An AV fistula uses your own vein, surgically connected to an artery, to create a high-flow access point. It is the preferred option because it lasts longer, has lower infection rates, and requires less maintenance. An AV graft uses a synthetic tube to connect the artery and vein when a patient's own veins are not suitable for a fistula. Grafts can be used sooner after placement but require more ongoing maintenance. Your vascular surgeon will evaluate your veins with ultrasound and recommend the best option for your anatomy.

  • Can a dialysis fistula or graft be repaired if it stops working? +

    Yes. When a fistula or graft develops problems — such as narrowing, clotting, or poor flow — there are several minimally invasive procedures that can restore function. A fistulogram uses X-ray imaging and contrast dye to assess the access; angioplasty uses a small balloon to open narrowed segments; declotting procedures restore flow when a clot forms. Most of these can be performed in an outpatient setting. Vascular Wellness Institute provides the full range of dialysis access maintenance services at both our Sarasota and Bradenton locations.

  • Does VWI coordinate with my nephrologist for dialysis access care? +

    Yes. Vascular access for dialysis is a team effort between your nephrologist and your vascular surgeon. We work closely with nephrology practices throughout Manatee and Sarasota County to ensure timely access planning, clear communication about access readiness, and coordinated follow-up care. If you are being followed by a nephrologist and need a referral to a vascular surgeon for access planning, your nephrologist can refer you directly, or you can call our office to schedule.