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Published on: May 31, 2022
Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care
1University of Texas Medical Branch and Lifeline Vascular Access, Houston, Texas, USA.
Insights
Patients receiving dialysis vascular access care in freestanding dialysis access centers (DACs) experience better outcomes than those treated in hospital outpatient departments. DACs demonstrate improved safety and economic benefits for dialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Dialysis vascular access is crucial for patients requiring renal replacement therapy.
- Effective planning, creation, and management of vascular access are essential for patient well-being.
- Interventional nephrology is emerging as a key subspecialty, with nephrologists increasingly managing vascular access.
Purpose of the Study:
- To compare clinical outcomes of dialysis vascular access management between freestanding dialysis access centers (DACs) and hospital outpatient departments (HOPDs).
- To evaluate the safety, effectiveness, and economic impact of interventional nephrologists managing dialysis access in DACs.
Main Methods:
- A retrospective study using United States Medicare claims data.
- Propensity score matching was employed to compare a DAC patient group (n=27,613) with an HOPD patient group (n=27,613).
- Clinical outcomes, including infections, hospitalizations, and mortality, were analyzed.
Main Results:
- Patients treated in DACs exhibited significantly better clinical outcomes compared to those in HOPDs (P<0.001).
- DAC patients had fewer vascular access-related infections (0.18 vs. 0.29).
- Lower rates of septicemia-related hospitalizations (0.15 vs. 0.18) and a lower mortality rate (47.9% vs. 53.5%) were observed in the DAC group.
Conclusions:
- Freestanding dialysis access centers provide a safe, effective, and economical approach to managing dialysis vascular access.
- Interventional nephrologists play a vital role in improving patient outcomes through specialized care in DACs.
- DACs are associated with superior clinical results, including reduced infection and mortality rates for dialysis patients.
Abstract:
Dialysis vascular access planning, creation, and management is of critical importance to the dialysis patient population. It requires a multidisciplinary approach involving patients and their families, dialysis facility staff, the nephrologist, the surgeon, and the interventionalist. With the emergence of interventional nephrology as a subspecialty of nephrology, the nephrologist is increasingly providing both the nephrology and interventional aspects of care, and in some areas, the surgical functions as well. Most of these interventional nephrologists work in freestanding outpatient dialysis access centers (DACs). Large clinical studies published over the past 10 years demonstrate that the interventional nephrologist can manage the problems associated with dialysis access dysfunction effectively, safely, and economically. A recently published study based upon United States Medicare claims data in which a DAC patient group (n = 27,613) and a hospital outpatient department patient group (HOPD group; n = 27,613) were compared using propensity score matching techniques showed that patients treated in the DACs had significantly better clinical outcomes (P<0.001). This included fewer vascular access-related infections (0.18 vs. 0.29), fewer septicemia-related hospitalizations (0.15 vs. 0.18), and a lower mortality rate (47.9% vs. 53.5%).
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