Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative

Nephrol Dial Transplant. 2007 Sep;22(9):2595-600. doi: 10.1093/ndt/gfm221. Epub 2007 Apr 23.


Background: In the Netherlands, arteriovenous fistulas (AVFs) are used in 60-65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs.

Methods: Physicians and dialysis staff in 11 participating centres (N=1092 vascular accesses) were strongly and repeatedly advised to adhere to current guidelines with extra attention for pre-operative duplex examination and salvaging of failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses using an internet-linked database. In 22 other centres (N=1566 accesses), the CIMINO programme was not offered and they were considered the control group.

Results: On 1 January 2006, average follow-up time of the CIMINO group and the control group were 13.3 months and 34.1 months, respectively. A total of 598 new vascular accesses (77% AVFs) were created in the CIMINO group. Prevalent AVF use increased from 58.5% (range: 31-79%) to 62.7% (range: 45-83%) in the CIMINO group and from 65.5% (range: 31-91%) to 67.3% (range: 42-91%) in the control group. The increase in AVF use per year was significantly quicker than in the control group (P<0.05). Use of untunnelled catheters decreased whereas that of tunnelled catheters increased.

Conclusions: This initiative shows that a multicentre guidelines implementation programme results in an accelerated increase of AVF use in comparison with a time control group. These data suggest that the choice of access placement depends predominantly on centre-specific factors.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arteriovenous Shunt, Surgical / statistics & numerical data*
  • Case-Control Studies
  • Catheters, Indwelling
  • Demography
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Male
  • Middle Aged
  • Netherlands
  • Prevalence
  • Renal Dialysis*