A patient with severe hypertension who is to start hemodialysis and does not have diabetes or cardiac issues is preferable to have what type of access?

For a patient with severe hypertension who is starting hemodialysis and does not have diabetes or any cardiac issues, a fistula is the preferred type of vascular access. The primary reason for this preference is that a fistula, typically an arteriovenous (AV) fistula, involves creating a connection between an artery and a vein, which allows for high blood flow rates needed during dialysis.

Fistulas have several advantages. They are less prone to infection compared to catheters, as they are created from the patient's own blood vessels. This means a reduced risk of complications over the long term, which is particularly important for patients who will be on long-term dialysis. Fistulas also tend to have greater durability, provide better blood flow, and result in fewer clotting issues than other access methods, which is crucial for effective dialysis treatment.

In the context of this patient’s condition, despite having severe hypertension, the absence of diabetes or cardiac issues suggests a lower risk for complications that may arise with other types of access. Thus, a fistula is suitable as it combines safety, efficiency, and longevity for regular hemodialysis sessions.

Alternative access methods like catheters or grafts carry higher risks of infection, thrombosis