Vascular Access Considerations in Home Hemodialysis.

There is a global interest in expanding home dialysis utilization amongst patients with end-stage kidney disease. Home hemodialysis (HHD) is an appealing kidney replacement therapy option for this population due to its multiple clinical and quality of life benefits. Central to successful HHD is the establishment and maintenance of a functioning vascular access that serves as a patient's lifeline while on therapy. While the selection of a vascular access type is influenced by individual patient circumstances, the arteriovenous fistula is generally the preferred access method. Training patients to utilize their dialysis access requires attention to safety, risk management, and monitoring for complications to minimize adverse events and technique failure. Policies incorporating systematic frameworks for quality improvement and assurance, in conjunction with the measurement of metrics relating to vascular access, are tools that should be employed by HHD programs to enhance the value of care delivered. In this Perspective, we aim to describe what is currently known about the various vascular access options in HHD and to elucidate what needs to be taken into consideration in the selection and care of this access.