We recommend the placement of forearm autogenous arteriovenous access as the first choice for primary access for hemodialysis (Grade 1, Level C).

1. When arterial and venous anatomy is suitable, placement of autogenous radial-cephalic direct wrist access (Brescia-Cimino-Appel) or autogenous posterior radial branch-cephalic direct wrist access (snuffbox) is recommended.
2. In the case where arterial or venous anatomy does not allow placement of a direct access, forearm vein transposition or translocation are recommended. These procedures should use the maximal length of adequate vein and use arterial inflow from the forearm tailored to accommodate this length of vein.