Commentary: The risks of vascular access

Fatal vascular access hemorrhage is considered a rare complication of hemodialysis (HD). Ellingson et al. indicate otherwise, and their data suggest that it causes 0.4–1.6% of deaths in US HD patients. It is more common with grafts than fistulas, and many victims have had previous access hemorrhages. The widespread presumption that a fistula is the best, and a cuffed catheter the worst, access for HD patients needs reassessment, particularly in older, sicker patients.