Improving vascular access creation among hemodialysis patients: An agent-based modeling and simulation approach

Chronic kidney disease is a worldwide public health problem, and vascular access is known as hemodialysis patients' lifeline. Hemodialysis is the most common treatment for kidney replacement. The choice of vascular access should be "patient-centered." However, the preferred or optimal type of vascular access that is generally recommended by clinical guidelines for hemodialysis patients is a native Arteriovenous Fistula (AVF). Despite the recommendations of the guidelines, unfortunately, many hemodialysis patients undergo dialysis through the catheter. Thus, this issue must be controlled by healthcare providers to reduce the adverse events of choosing this access for patients. As such, the prevalence of the concept of "first fistula, catheter last," identification of barriers to catheterization and effective factors in the use of native venous arterial fistula, as well as evaluating its impact on improving health and quality of life should be considered. To this aim, we have developed an agent-based simulation to investigate the effects of different agents on this process, as well as plan to achieve the desired status for improving and optimizing vascular access creation and maintenance. The decisions and behaviors of the stakeholders (agents) play a critical role in hemodialysis processes, so we have simulated their behaviors and decisions that are the most essential factor in establishing the system's status. To understand and evaluate the current situation, several experts, including nephrologists, surgeons, and dialysis nurses have been recruited to detect the factors influencing this process plus the relevant stakeholders, and their roles and effects. Our study has shown that agent-based modeling has a great potential in developing a simulation model to improve vascular access creation among hemodialysis patients.