[Two centers with a native fistula prevalence higher than 90%: organization and activity]

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Vascular access (AV) dysfunction is a primary cause of morbidity and hospitalization in hemodialysis patients.
• Guidelines recommend native arteriovenous fistulas (nAVF) as the gold standard, yet central venous catheters (CVC) are increasingly prevalent.
• This study investigates factors contributing to high nAVF prevalence in two dialysis units.

Purpose of the Study:

• To compare the operational activities of two dialysis units with high nAVF prevalence (>90%).
• To identify reasons for the sustained high prevalence of nAVF.
• To analyze vascular access creation and management policies.

Main Methods:

• Comparative analysis of two dialysis units' policies and organizational models.
• Assessment of surgeon involvement, dedicated nephrologists, pre-operative ultrasound, complication monitoring, and interventional radiology use.
• Analysis of patient demographics (age, dialysis duration, diabetes) and AV access types (nAVF, CVC, AV graft) as of December 31, 2007.
• Evaluation of AV incidence over the preceding four years.
• Statistical analysis using T-student and Chi-square tests.

Main Results:

• Both centers demonstrated high nAVF prevalence (92.5% in Pescara, 96.1% in Lecce).
• Forearm nAVF constituted over 80% and 90% of accesses in Pescara and Lecce, respectively.
• No significant differences in organizational models were found; both utilized routine ultrasound, prompt surgical intervention for thrombosis (12-24 hours), and timely correction for stenosis (within 15 days).
• Both centers featured multidisciplinary teams (nephrologist, vascular surgeon, interventional radiologist) coordinated by nephrologists.
• Incident interventions showed a high percentage of forearm AVF revisions for complications, with minimal use of proximal AVF or grafts.

Conclusions:

• High prevalence of native arteriovenous fistulas is achievable through consistent policies and effective multidisciplinary team collaboration.
• The study highlights the importance of forearm nAVF utilization and timely management of complications.
• Organizational similarities and a coordinated team approach appear crucial for maintaining high nAVF rates.