title: Managing the lifeline: preemptive access management for better outcomes for hemodialysis patients and programs. Medical Review Board of The Renal Network, Inc.
abstract: Problems with vascular access for hemodialysis patients contribute substantially to the morbidity, mortality, and high costs associated with renal replacement therapy. Data from the Network 9/10 Regional Hemodialysis Vascular Access Quality Improvement Project show evidence of incremental improvements, with more native vein fistulae and fewer grafts. However, increased numbers of catheters were observed, and still fully 32% of the catheters in place were associated with no internal access created after more than 90 days on dialysis. This article reviews recent contributions to understanding patterns of access-related care, pathophysiology of vascular access complications, and new approaches to achieving the preferred native vein arteriovenous fistulae. A financial analysis shows that dialysis units that employ dedicated access management personnel can expect bottom-line benefits that will easily cover the added expense. These benefits will be in addition to improvements in morbidity and mortality for patients.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Silver
authors.forename: J A
authors.initials: JA
authors.lastname: Cain
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis; D014487:Centers for Medicare and Medicaid Services, U.S.; D006282:Health Personnel; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007087:Illinois; D007196:Indiana; D007629:Kentucky; D009820:Ohio; D011785:Quality Assurance, Health Care / Q000379:methods; D012017:Referral and Consultation; D006435:Renal Dialysis; D017749:Total Quality Management; D014481:United States