A dedicated vascular access program can improve arteriovenous fistula rates without increasing catheters

J Vasc Access. Oct-Dec 2008;9(4):254-9.

Abstract

Purpose: We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates.

Methods: A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients.

Results: The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85-0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09-2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85-0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact.

Conclusion: We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical / statistics & numerical data*
  • British Columbia
  • Catheters, Indwelling / statistics & numerical data*
  • Female
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Likelihood Functions
  • Male
  • Middle Aged
  • Odds Ratio
  • Practice Guidelines as Topic
  • Program Development
  • Program Evaluation
  • Renal Dialysis*
  • Retrospective Studies
  • Sex Factors
  • Time Factors