The aims of this study are to:

• Determine the AVF (arteriovenous fistula) survival of patients submitted to MuST compared to those submitted to RL (rope-ladder).
• Determine the AVF (arteriovenous fistula) complication rate of patients submitted to MuST compared to those submitted to RL (rope-ladder).
• Analyze the intensity of pain perceived by the patient with each cannulation technique under study.

The MuST is based on the association between the RL technique in that it uses the entire length of the available vessel through progressive rotation, and the buttonhole (BH) cannulation technique since there are three specific cannulation sites for each cannulation day during the week, meaning that each site is only cannulated once a week (allowing the puncture site to heal in between cannulations).

Inclusion Criteria:

• Voluntarily agree to participate in the study and sign an informed consent;
• Are on a regular haemodialysis (HD) program with three weekly sessions;
• AVF has been in use for at least 4 weeks without incident;
• AVF with blood flow (Qa) ≥500 mL/min evaluated by thermodilution;
• AVF paths allow cannulations along the entire length of the vein with at least 6 cm of distance between bevels, or two distinct areas of 3 cm in length;
• Adult patients

Exclusion Criteria:

• Those who decline to take part;
• Those who have undergone angiography or surgical intervention in the last 4 months in the AVF in use;
• Those who have undergone three or more interventions in the AVF in use;
• Those with use of anesthetic creams at cannulation sites.