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Nephrologist care for 12 months or more increases hemodialysis initiation with permanent vascular access

Daijo Inaguma1, Ryoichi Ando2, Masato Ikeda2

  • 1Department of Nephrology, Nagoya Daini Red Cross Hospital, Myoken-cho 2-9, Showa-Ku, Nagoya, Aichi, 466-8650, Japan. inaguma@nagoya2.jrc.or.jp.

Clinical and Experimental Nephrology
|July 5, 2011
PubMed

Insights

Early referral to nephrologists significantly increases the availability of permanent vascular access, such as arteriovenous fistulas or grafts, for patients starting hemodialysis. This ensures better preparation for maintenance hemodialysis.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Public Health

Background:

  • Optimal vascular access (VA) is crucial for initiating maintenance hemodialysis (HD).
  • Insufficient pre-HD management in patients with less than 3 months of nephrologist follow-up often necessitates urgent HD initiation.
  • This study focuses on patients with at least 3 months of nephrologist care to assess early referral impacts.

Purpose of the Study:

  • To evaluate the effect of early referral (ER) to nephrologists on vascular access (VA) type at the initiation of maintenance hemodialysis (HD).
  • To determine if ER influences the availability of permanent VA options.

Main Methods:

  • Retrospective observational study involving 940 patients across 9 institutions.
  • Patients were categorized into early referral (ER; ≥12 months nephrologist follow-up) and late referral (LR; 3-12 months follow-up) groups.
  • Comparison of VA type available at HD initiation between ER and LR groups.

Main Results:

  • Early referral (ER) was significantly associated with the availability of permanent VA (arteriovenous fistula or graft) at HD initiation (OR 1.705, P=0.001).
  • Multivariate analysis confirmed ER's significant association with permanent VA availability (OR 1.509, P=0.023).

Conclusions:

  • Early referral to nephrologists is advantageous for increasing the likelihood of permanent VA availability.
  • These findings hold true even when excluding patients with less than 3 months of pre-HD nephrologist follow-up.
Abstract

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