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Related Experiment Video

Updated: May 16, 2026

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

Published on: May 31, 2022

Systemic barriers to optimal hemodialysis access.

Ionel Z Donca¹, Jay B Wish

¹Division of Nephrology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.

Seminars in Nephrology

|December 11, 2012

Summary

This summary is machine-generated.

Arteriovenous fistulas (AVFs) are the preferred hemodialysis access, offering better outcomes and lower risks. This initiative identifies patient, physician, and system factors hindering AVF use in the US.

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Area of Science:

Nephrology
Vascular Surgery
Healthcare Systems Analysis

Background:

Arteriovenous fistulas (AVFs) are the gold standard for hemodialysis vascular access due to superior patency, fewer complications, better adequacy, lower costs, and reduced mortality.
The Fistula First Breakthrough Initiative aims to increase prevalent AVF use to 66%, decrease central venous catheter (CVC) use, and lower vascular access complication rates in hemodialysis patients.

Purpose of the Study:

To identify systemic root causes for the significantly lower AVF utilization rate in the United States compared to other industrialized nations.
To summarize current controversies in improving AVF placement and reducing CVC use, categorized by patient, physician, and system factors.

Main Methods:

A multidisciplinary team was assembled in 2009 by the Fistula First Breakthrough Initiative.
A root cause analysis was performed to identify factors contributing to low AVF use.
Identified root causes were categorized into patient, physician, and system domains.

Main Results:

139 latent root causes for low AVF utilization were identified.
These causes were systematically categorized into patient, physician, and system-level issues.
The analysis provides a framework for understanding and addressing barriers to AVF adoption.

Conclusions:

Improving AVF placement and reducing CVC use requires a multifaceted approach addressing patient, physician, and systemic barriers.
Collaborative efforts among healthcare professionals and systems are crucial for optimizing vascular access in hemodialysis patients.
Addressing the identified root causes is essential for achieving national AVF use goals and improving patient outcomes.