Buttonhole cannulation is superior in securing hemostasis as compared to conventional cannulation, but not in reducing pain and ease of cannulation. More educational workshops should be conducted to improve the skill

Hemodialysis patients are a group of critically ill patient with multiple co-morbidities as the risk factors of developing vascular access complications and death. Creation of fistula before initiation of hemodialysis will reduce the IJC related complications. Vascular access complications will contribute to the increased mortality and socioeconomic burden.

In this study, the frequency of infection and thrombosis were not significantly increased in the buttonhole group but it might be due to small sample size, high dropout rate and short duration of the study. The practice of buttonhole cannulation should be encouraged provided cost is not a factor.