Which approach is recommended for patients with chronic kidney disease and the presence of an arteriovenous (AV) fistula?

Consulting with a nephrologist before any procedures is recommended for patients with chronic kidney disease and the presence of an arteriovenous (AV) fistula because these specialists can assess the patient's specific condition, comorbidities, and overall management strategies. Given the complexities associated with chronic kidney disease and its impact on vascular access, a nephrologist's expertise ensures that the chosen approach minimizes potential complications while maintaining optimal patient outcomes. This collaboration can help determine the best course of action regarding both dialysis access and the preservation of existing fistulas.

The other options do not align with the standard of care for these patients. Using veins in the arm may not be advisable since utilizing other venous access sites could compromise the AV fistula. Accessing through the saphenous vein is typically not suitable because it is not as directly related to vascular access for dialysis and could present issues in the context of existing dialysis fistulas. Exclusively utilizing brachial veins may limit access options and could lead to increased complications. Therefore, engaging a nephrologist provides a comprehensive evaluation tailored to the patient's specific vascular access needs.