Vascular Access Care and Treatment Practices Associated with Outcomes of Arteriovenous Fistula: International Comparisons from the Dialysis Outcomes and Practice Patterns Study

Abstract

Background: Vascular access (VA) guidelines recommend the native arteriovenous fistula (AVF) as VA of first choice for chronic hemodialysis patients. AVF management is important in hemodialysis patient care. AVF survival is associated with various physical factors, but the effects of dialysis treatment factors upon AVF survival are still not clear. Methods: Study patients were treated at 498 dialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 or 3 (2002-2007). Analyses included 1,183 incident hemodialysis patients (on dialysis ≤7 days and using an AVF at study entry) and 949 prevalent patients (on dialysis >7 days at DOPPS entry and using a new AVF created during study observation). AVF survival was modeled from the study entry date for incident patients and date of first AVF use for prevalent patients. Predictors of primary and final AVF survival were compared across Japan, North America and Europe/Australia/New Zealand (EUR/ANZ) with adjustments for patient characteristics. Results: No meaningful relationship was seen between AVF survival and various physician and staff practices. However, patients with prior catheter use displayed higher rates of primary and final AVF failure. Final AVF failure rates were higher in facilities with higher median blood flow rates (BFR). They were also greater in North America and EUR/ANZ than in Japan, but this difference was substantially attenuated after accounting for regional differences in facility median BFR. Conclusion: AVF longevity differed according to the DOPPS region, and was related to prior patient catheter use and facility BFR practice. Further longitudinal studies may help demonstrate meaningful associations between VA-handling skill and patency.

Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

“…Additionally, a direct comparison with North American series may be vitiated by the predominance of the male gender, vast majority of Caucasian patients and lack of data on obesity. However, prevalence of diabetes (40.4%) and cardiovascular comorbidities was similar to that described in North American patients [9] and VA survival was not influenced by a different practice in the prescription of blood flow rate because it was close to the average of 400 ml/min used in the United States [46] .…”

Gender, low Kt/V, and mortality in Japanese hemodialysis patients: Opportunities for improvement through modifiable practices

“…Blood flow rates in Japan are substantially lower than those in the 11 other countries in DOPPS 4 with a BFR ≤220 mL/min prescribed for 80% of patients. A lower BFR may allow more frequent use of AVF with longer AVF patency in Japan compared with other countries . However, despite this possibility, our mortality analyses indicate that, overall, a slightly higher BFR either at the patient level or as a facility practice in Japan is associated with a substantially lower mortality rate.…”

Arteriovenous Fistula Maturation in Prevalent Hemodialysis Patients in the United States: A National Study

“…Furthermore, there are meaningful differences in the comorbidities of the dialysis population, access to predialysis CKD care, and in the organization of ESRD care among these countries. 2, 15, 46, 48, 49 These data suggest that there is more to early cannulation than merely early needle placement. Additional attention to training for both the nephrologist and surgeon are likely beneficial.…”