### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
my daughter who hav veins that are no good need to ahve a surgery for fistula or the one in goes into th nect - she is 22 yo 64 lbs & only 4 feet.  her kidneys are below 15% use.  she has had over 50 surgeries adn is afaraid of this on.  she had flatlined when she was 12 from th halo surgery.  she was born with scoliosis, imperfertaed anus & reflux of the bladder.  she needs to make a deciede between the two which to do.  the arm fistula we were told can cause her to loss some function and the neck causes infections.  which is the lesser of 2 evils as they say in you opinion

### output:

Hi and thanks for asking this important question. Most people who reach Stage 5 CKD (kidney function less than 15%) face the dilemma of choosing between the limited options confronting them. These are - Renal transplant, Hemodialysis, Peritoneal dialysis and Conservative treatment (letting nature take its course). The last option is opted by some elderly who are already frail from other medical problems. Transplant is by far the best option, but availability of organ is the problem. Daily hemodialysis is the next best option, but many find it quite tedious in the beginning to dialyze daily. 3 times a week hemodialysis and Peritoneal dialysis both stand jointly at third position. For those who chose Hemodialysis, FISTULA is by far the best option for many reasons (less infection, lasts longer, good flow and hence we can achieve better dialysis, etc.). If forming a fistula is not possible due to various reasons, A-V GRAFT is next best and last come the CATHETER. I would definitely recommend a fistula as the first option. Best wishes. RB