Associations with predialysis vascular access management

Area of Science:

• Nephrology
• Vascular Surgery
• Public Health

Background:

• Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines promote arteriovenous fistulae for hemodialysis.
• Optimal outcomes necessitate predialysis nephrologist follow-up, vascular access placement, and maturation.

Purpose of the Study:

• To assess clinical factors influencing predialysis vascular access management in incident hemodialysis patients.
• To evaluate adherence to K/DOQI guidelines regarding vascular access for new dialysis patients.

Main Methods:

• Retrospective analysis of 157 incident hemodialysis patients over a 2-year period.
• Assessment of predialysis nephrology follow-up, vascular access surgery, and initial dialysis access type.
• Comparison of outcomes between diabetic and non-diabetic patients.

Main Results:

• Only 35% of patients initiated dialysis with permanent access; 67.3% of these were fistulae.
• Diabetic patients showed significantly higher rates of predialysis nephrology follow-up (81.5%), surgery (56.5%), and permanent access (43.5%) compared to non-diabetics.
• Patient age, sex, and race did not predict predialysis access management.

Conclusions:

• A significant majority (65%) of incident hemodialysis patients started treatment with a catheter, indicating challenges in meeting K/DOQI goals.
• Diabetes was associated with improved predialysis vascular access management and higher fistula utilization.
• Early nephrology referral for non-diabetic chronic kidney disease patients is crucial to enhance arteriovenous fistula use.