Unraveling the realities of vascular access: the Network 11 experience

Adv Ren Replace Ther. 2000 Oct;7(4 Suppl 1):S65-70.


Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arteriovenous Shunt, Surgical* / statistics & numerical data
  • Blood Vessel Prosthesis / statistics & numerical data
  • Catheters, Indwelling / statistics & numerical data
  • Centers for Medicare and Medicaid Services, U.S.
  • Child
  • Child, Preschool
  • Female
  • General Surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Nephrology
  • Referral and Consultation*
  • Renal Dialysis*
  • Total Quality Management
  • United States