About 92% of the incident dialysis patients in the United States undergo conventional HD, typically carried out thrice-weekly in a designated HD unit, ie, in-center dialysis, with typical treatment times of 3–4 h. Some centers offer nocturnal HD where patients sleep during treatment by slow, low-efficiency dialysis. Home HD is conducted in the home environment, 5–6 sessions weekly for 2.5–3 h. Control of BP and phosphorus are superior with PD, nocturnal PD, and home HD compared to conventional thrice-weekly HD.
Optimal HD requires a well-functioning vascular access and this can be provided via an autogenous AVF (arteriovenous fistulas), bioprosthetic AVG (arteriovenous grafts), or HD catheters. The AVF is the best HD vascular access and most closely satisfies the requirement for adequate blood flow delivery to the dialysis machine, and has the lowest maintenance cost among all vascular access types. Notably, the failure of access function limits the delivered dose of dialysis, a major survival determinant.