ABSTRACT
In the USA alone, there are over 214000 patients undergoing some form of dialysis, providing the renal replacement therapy necessary for life.1 The cost of maintaining this haemodialysis access in the USA was between 750 and 900 million dollars in 1995 and has easily exceeded $1 billion in 1996. Despite the fact that it has been acknowledged that the native fistula (e.g. Brescia-Cimino radiocephalic fistula) is the haemodialysis access of choice, only 15-20% of patients in the USA have this type of access. The overwhelming majority have artificial (polytetrafluoroethylene [PTFE]) conduits or catheters.2, 3 These remarkable percentages are in direct contrast with the European and Japanese experience, where nearly 90% of dialysis patients have the preferable native fistulae. One of the major urgent goals in the USA is to increase the percentage of patients receiving native fistulae to the 40% level.1
