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Has the Fistula First Breakthrough Initiative caused an increase in catheter prevalence?
1Dialysis Management Medical Group, San Francisco, California94109, USA. vampdoc@aol.com
Insights
Central venous hemodialysis catheters (CVC) use remains high despite efforts to reduce it. This study examines the impact of the "Fistula First" initiative on CVC use in hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Access
- Public Health Initiatives
Background:
- Central venous catheters (CVCs) are frequently used for hemodialysis (HD) access in both incident and prevalent patients.
- Despite various strategies to reduce CVC use, placement rates have notably increased since 1996.
- Factors such as late referral and the "Fistula First" (FF) initiative have been associated with rising CVC utilization.
Purpose of the Study:
- To evaluate the actual impact of the "Fistula First" initiative on the rates of central venous catheter use in hemodialysis patients.
- To challenge the notion that the FF initiative has led to an increase in CVC placement.
- To present data demonstrating that catheter rates have remained stable.
Main Methods:
- Analysis of epidemiological data on hemodialysis access in a defined patient population.
- Comparative assessment of CVC and arteriovenous fistula (AVF) utilization trends before and after the implementation of the FF initiative.
- Statistical evaluation to determine the correlation between FF initiative promotion and CVC usage patterns.
Main Results:
- The study's data indicate that central venous catheter rates have not significantly changed.
- While the "Fistula First" initiative has successfully increased arteriovenous fistula placement and use, it has not concurrently driven an increase in CVC use.
- Observed trends suggest that CVC utilization has remained consistent despite the focus on AV fistula creation.
Conclusions:
- The "Fistula First" initiative's effect on central venous catheter use is not an increase, contrary to some suggestions.
- Hemodialysis catheter rates appear to be independent of the increased focus on arteriovenous fistulae.
- Further research may be needed to understand the persistent high rates of CVC use and explore alternative strategies for vascular access optimization.
Abstract:
The use of central venous hemodialysis catheters (CVC) continues to be high among the incident as well as the prevalent HD patients. Whereas many strategies have been implemented to decrease the use of CVCs, their placement rates have doubled since 1996. While many factors, including late referral, are responsible for the increased use of CVCs, the arteriovenous Fistula First Breakthrough Initiative (known as "Fistula First" [FF]) has also been implicated in the increased use of CVCs. It has been suggested that while the FF initiative has resulted in a substantial increase in arteriovenous fistulae placement and use, it has also resulted in an increase in the use of CVCs. This report argues that catheter rates have remained unchanged and provides data regarding the impact of the FF initiative on catheter use.
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