Long-term safety of buttonhole cannulation and efficacy of mupirocin prophylaxis

Buttonhole cannulation has drawn considerable interest in recent years, particularly with the proliferation of home hemodialysis. Touted benefits of this cannulation method include reduced pain, ease of use, reduced aneurysm formation, and overall greater patient satisfaction. However, recent studies have also suggested that systemic and local infection rates are higher with buttonhole cannulation compared with the standard rope-ladder method. In this review, we summarize recent systematic review findings and practice guidelines addressing the benefits and harms of buttonhole cannulation, and discuss the role of topical antimicrobial prophylaxis.