The Achilles' Heel of the Hemodialysis Patient

As an infant, Achilles was dipped by his mother Thetis into the River Styx to make him proof against all men's weapons. Unfortunately, the heel by which his mother held him did not get covered. Achilles was killed when Paris shot him in the heel with a poisoned arrow, directed by Apollo, the patron of physicians! The similarity of the Achilles' heel to the blood access sites of a hemodialysis patient is striking. The weakest spot in a dialysis patient is usually the wrist, not the heel. Infections and mechanical difficulties in the arteriovenous fistula are great problems.

Since Scribner's first description of long-term hemodialysis in 1960,¹ the increase in the number of patients on hemodialysis programs has been exponential. The last report from the European Dialysis and Transplant Registry includes over 60,000 patients on long-term hemodialysis programs in the world.² The cumulated six-year survival is now more