Hemodialysis access success: beyond the operating room

Area of Science:

• Nephrology
• Vascular Surgery
• Healthcare Management

Background:

• The Veterans Health Administration (VHA) increased focus on arteriovenous (AV) hemodialysis (HD) vascular access, driven by Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines.
• Individual VHA centers were responsible for meeting KDOQI goals for AV HD vascular access.
• A dedicated HD AV clinic was established for preoperative evaluation and postoperative follow-up to address these goals.

Purpose of the Study:

• To evaluate the effectiveness of a dedicated AV HD clinic in managing vascular access.
• To assess the maturation and secondary intervention rates for AV fistulae.
• To determine the overall AV fistula use rate within the VHA.

Main Methods:

• Retrospective review of 130 patient records referred to the AV HD clinic from January 2004 to June 2006.
• Inclusion criteria required a minimum of 6 months of postoperative follow-up.
• Analysis of AV fistula types, maturation rates, secondary interventions, and final use rates.

Main Results:

• AV fistulae were created in 71% of patients, with Brescia-Cimino fistulae comprising 45% of these.
• Only 38% of AV fistulae matured successfully without secondary intervention.
• The remaining 62% required an average of 2.2 interventions; the final AV fistula use rate was approximately 85%.

Conclusions:

• Continued VHA support for dedicated AV HD teams and clinics is crucial for meeting KDOQI guidelines.
• The high rate of secondary interventions needed for AV fistula maturation underscores the importance of specialized care.
• Dedicated HD access teams can improve the assessment and organization of interventions, thereby promoting AV fistula use.