Assessing medical care of dying residents in nursing homes

A rational approach to hemodialysis access in the patient with renal failure requires an understanding of many factors. The initial approach to such patients and subsequent decisions have a significant impact on quality of life as well as the morbidity of access choices. Autogenous vascular access remains the gold standard in the care of these patients. Alternatives are less desirable but are necessary in an increasing number of situations. Careful thought before embarking on a procedure will provide better long-term function and preserve the patient's options for the future.