As a result, catheters used long-term without appropriate adjustments in treatment duration can compromise dialysis adequacy. Chronic catheter access is associated with a risk of central venous stenosis. Patients should be educated on these issues and strongly encouraged to allow creation of an AV fistula for permanent access where appropriate. The rate of graft thrombosis should not exceed 0.5 thrombotic episodes per patient year at risk. The rate of thrombosis is largely determined by the presence of unrecognized hemodynamically significant stenosis.
Native accesses have a much lower thrombosis rate compared to prosthetic grafts.
4 Sequential measurements of flow can detect deterioration of native access function. All of these strategies should reduce the risk of thrombotic failure. The Work Group concluded that a thrombosis rate of 0.25 episodes per patient year in native fistulae is achievable. Infectious complications of accesses are a leading cause of morbidity and mortality in dialysis patients. By proposing these goals for 30-day primary failure rates for various graft configurations, the Work Group does not wish to imply that upper arm grafts should be elected over forearm grafts solely on the basis of these recommended primary failure rates.