What type of access is preferable for a 40-year-old patient with severe hypertension and no diabetes or cardiac problems starting on hemodialysis?

An arteriovenous fistula is the preferred type of access for a patient starting hemodialysis, especially for someone who is 40 years old with severe hypertension but has no diabetes or cardiac problems. The rationale for choosing an arteriovenous fistula includes its longevity, lower risk of infection, and better overall function compared to other forms of access.

An arteriovenous fistula is created by surgically connecting an artery to a vein. This allows the vein to accommodate the increased blood flow, which is crucial for effective hemodialysis. Fistulas have a longer lifespan compared to grafts or catheters, often providing access for years, which is beneficial for patients who may need prolonged dialysis treatment.

Additionally, because the access is created from the patient's own blood vessels, the likelihood of infection is lower. This is particularly important for patients undergoing frequent dialysis sessions, where the risk of complications from access sites can significantly impact overall health.

In contrast, other access types like catheters or grafts may have a higher incidence of complications, such as thrombosis and infection. Therefore, in the context of no existing comorbid conditions that could complicate the procedure or its function, an arteriovenous fistula