Age should not be a limiting factor when determining candidacy for AVF creation due to equivalent survival and procedural rates. Failure of fistula maturation is a primary concern to patients of all ages and demands further study.

Citrate 4% has equivalent or better outcomes with regards to catheter exchange, TPA use and access-related hospitalizations compared with heparin locking. It is a safe and less expensive alternative. Randomized trials comparing these anticoagulants with a control group would definitively determine the optimal haemodialysis catheter locking solution.

For hemodialysis patients, the physical complications associated with needle cannulation of fistulas and grafts are a major source of dissatisfaction, while infectious complications, including catheter-related infections, are not a significant source of their concerns. Future research should focus on developing methods to effectively: (i) reduce the fear and pain associated with cannulation and (ii) educate patients about the risks associated with vascular access-related infection.

The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.