UK organisation of access care

Area of Science:

• Nephrology
• Vascular Surgery
• Public Health

Background:

• Most patients in the UK initiate renal replacement therapy (RRT) with haemodialysis (HD).
• A significant majority start HD using temporary non-permanent vascular access, such as tunnelled or non-tunnelled lines.
• The prevalence of long-term access like arteriovenous fistulas (AVF) or grafts (AVG) remains suboptimal at 3 months.

Purpose of the Study:

• To analyze the current trends in vascular access for haemodialysis initiation in the UK.
• To identify factors influencing the choice of vascular access at the start of HD.
• To assess the impact of referral timing on achieving optimal vascular access for HD patients.

Main Methods:

• Analysis of national UK audit data on renal replacement therapy (RRT) and haemodialysis (HD) access.
• Examination of patient referral patterns to nephrology and surgical services.
• Correlation of referral timing with the type of vascular access utilized at dialysis initiation.

Main Results:

• 73% of RRT patients start with HD, but 59% use non-permanent lines initially.
• Only 41% of patients utilize AVF after 3 months of HD.
• Late referral (within 90 days) to renal services affects one-fifth of incident HD patients, with surgeon referral timing impacting initial access choice.

Conclusions:

• Current vascular access practices for initiating HD in the UK are suboptimal, with a high reliance on temporary lines.
• Timely referral to surgeons for AVF/AVG creation before HD initiation is essential.
• Achieving national targets for AVF/AVG use requires improved pre-dialysis surgical referral strategies.