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Preventing vascular access dysfunction: which policy to follow
1Division of Nephrology, Department of Medicine, University of West Virginia School of Medicine, Morgantown, WV, USA. abesarab@pol.net
Insights
The US aims to improve hemodialysis vascular access by increasing autologous arteriovenous fistulas (AVFs) and enhancing access surveillance, thereby reducing catheter use. Policies promoting timely AVF creation are most impactful.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health Policy
Background:
- Current US Clinical Performance Measures focus on hemodialysis vascular access.
- Key measures include increasing autologous arteriovenous fistulas (AVFs) and reducing catheter use.
- Surveillance and preemptive correction of access dysfunction are critical.
Purpose of the Study:
- To outline strategies and resources for improving hemodialysis vascular access.
- To emphasize the importance of increasing AVF creation rates.
- To advocate for policies promoting AVF construction and access surveillance.
Main Methods:
- Analysis of existing Clinical Performance Measures in the USA.
- Discussion of strategies to meet performance targets for AVFs and reduce catheter use.
- Emphasis on the role of preemptive monitoring and surveillance.
Main Results:
- Policies promoting AVF creation and access surveillance are crucial for reducing catheter use.
- Increasing AVF rates in incident and prevalent hemodialysis patients is a primary goal.
- Timely AVF creation offers the most significant impact on vascular access outcomes.
Conclusions:
- A team approach is essential for successful implementation of vascular access policies.
- Policies should prioritize timely AVF creation and robust access surveillance.
- These initiatives are expected to reduce reliance on catheters in hemodialysis patients.
Abstract:
In the USA, three Clinical Performance Measures are currently in place: increasing the number of autologous arteriovenous fistulas (AVFs) among incident hemodialysis patients to 50% and to 40% in prevalent hemodialysis patients; to foster the surveillance of accesses with preemptive correction of problems before accesses thrombose or fail, and to reduce the use of catheters in prevalent patients to less than 10%. Reduction of catheters will automatically result from initiatives that increase the construction of AVFs and preemptive monitoring and surveillance of accesses for dysfunction. Therefore, policies that promote the latter two vascular access aspects are most important to develop and follow. Of these two, however, the most impact will be made by promoting a policy to increase AVF creation in the timeliest manner possible. Strategies and resources needed to achieve these policies are presented. The need for a team approach is emphasized.