Increasing the Use of Arteriovenous Fistula in Hemodialysis

Schön, Donald A.; Blume, S.; Niebauer, Kimberly; Hollenbeak, Christopher S.; Lissovoy, Gregory de

doi:10.2215/cjn.01880606

Cited by 66 publications

(47 citation statements)

References 21 publications

(14 reference statements)

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“…Several authors have identified changes in the process of care to improve the rate of AVF use among incident patients (22,26,27), and one author suggests financial incentive based on the cost-effectiveness of the AVF (28). Understanding patient preference, beliefs, values, and reasons for refusal will be necessary to appropriately address this significant proportion of eligible patients who simply refuse a permanent access.…”

Section: Discussionmentioning

confidence: 99%

Increased Hemodialysis Catheter Use in Canada and Associated Mortality Risk

Moist

Trpeski

et al. 2008

Clinical Journal of the American Society of Nephrology

133

117

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.6% to 18.6%, and grafts remained between 2.1% to 2.6%. Prevalent catheter use increased from 41.8% to 51.7%, and fistulas and grafts decreased from 46.8% to 41.6% and 11.4% to 6.7%, respectively. There was significant variation in incident and prevalent fistulae use among the provinces. Adjustment for differences in patient characteristics did not change these trends. Incident catheter use was associated with a 6 times greater risk of death compared with fistula or graft use combined.Conclusions: In Canada there has been a decrease in fistulae and grafts with a subsequent increase in catheters that is not explained by changes in patient characteristics. Vascular access use varied by province, suggesting differences in practice patterns. Because incident catheter use was associated with increased mortality, urgent measures are needed to develop strategies to decrease catheter use.

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Section: Discussionmentioning

confidence: 99%

Increased Hemodialysis Catheter Use in Canada and Associated Mortality Risk

Moist

Trpeski

et al. 2008

Clinical Journal of the American Society of Nephrology

133

117

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“…[3][4][5][6][7] Because AVF requires fewer angiographic procedures and revisions, use of an AVF can also reduce the cost of vascular access-related care up to fivefold, 8,9 and multiple sources suggest that use of an AVF is cost-effective when compared with other vascular accesses. 10,11 Ideally, the AVF is placed and ready to use at the initiation of HD, but this process is highly dependent on predialysis nephrology care. 12,13 In the United States, this complex process generally requires early nephrology referral, selection of HD as preferred dialysis modality, estimation of time to HD, surgical referral, vascular imaging, preoperative evaluation, operative procedure, frequent follow-up visits to assess AVF maturation, and sometimes repeat surgical procedures.…”

mentioning

confidence: 99%

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Hurst

Abbott

Raj

et al. 2010

Journal of the American Society of Nephrology

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A higher proportion of patients initiate hemodialysis (HD) with an arteriovenous fistula (AVF) in countries with universal health care systems compared with the United States. Because federally sponsored national health care organizations in the United States, such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD), are similar to a universal health care model, we studied AVF use within these organizations. We used the US Renal Data System database to perform a cross-sectional analysis of patients who initiated HD between 2005 and 2006. Patients who received predialysis nephrology care had 10-fold greater odds of initiating dialysis with an AVF (adjusted odds ratio [aOR] 10.3; 95% confidence interval [CI] 9.6 to 11.1). DVA/DoD insurance also independently associated with initiating HD with an AVF (aOR 1.4; 95% CI 1.2 to 1.5). Fewer patients initiated HD at a DoD facility, but these patients were also approximately twice as likely to use an AVF (aOR 2.3; 95% CI 1.2 to 4.6). In conclusion, patients in DVA/DoD systems are significantly more likely to use an AVF at initiation of HD than patients with other insurance types, including Medicare. Further study of these federal systems may identify practices that could improve processes of care across health care systems to increase the number of patients who initiate HD with an AVF.

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“…Therefore, given the increasing number of patients on HD in Brazil, 20 it is important to implement a care program to ESRD patients that includes establishing an adequate arteriovenous access prior to HD, which in turn may be cost-effective and ultimately improve these patients' quality of life. 18,23 Further investigations are needed to explore the characteristics of dialysis services that may influence establishing a permanent vascular access for HD.…”

Section: Discussionmentioning

confidence: 99%

Permanent vascular access in patients with end-stage renal disease, Brazil

Silva

Gómes²,

Andrade

et al. 2011

Rev. Saúde Pública

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METHODS:Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276). Data were from the TRS Project -"Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS:About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure ≤ 1 year; shorter dialysis therapy; having no private health insurance; living in the centralwestern, northeastern and southeastern regions of Brazil; and living in the northern region plus having no private health insurance. In the fi nal model there was found a positive association between the outcome and pre-dialysis care and no were association with socioeconomic and comorbidity variables. CONCLUSIONS:The study results showed that the focus should on predialysis care to increase the establishment of an arteriovenous vascular access before starting hemodialysis in Brazil.

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Increasing the Use of Arteriovenous Fistula in Hemodialysis

Cited by 66 publications

References 21 publications

Increased Hemodialysis Catheter Use in Canada and Associated Mortality Risk

Increased Hemodialysis Catheter Use in Canada and Associated Mortality Risk

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Permanent vascular access in patients with end-stage renal disease, Brazil

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