Preventing vascular access dysfunction: which policy to follow.
In the USA, three Clinical Performance Measures are currently in place: increasing the number of autologous arteriovenous fistulas (AVFs) among incident hemodialysis patients to 50% and to 40% in prevalent hemodialysis patients; to foster the surveillance of accesses with preemptive correction of problems before accesses thrombose or fail, and to reduce the use of catheters in prevalent patients to less than 10%. Reduction of catheters will automatically result from initiatives that increase the construction of AVFs and preemptive monitoring and surveillance of accesses for dysfunction. Therefore, policies that promote the latter two vascular access aspects are most important to develop and follow. Of these two, however, the most impact will be made by promoting a policy to increase AVF creation in the timeliest manner possible. Strategies and resources needed to achieve these policies are presented. The need for a team approach is emphasized.
Besarab
Anatole
A
Division of Nephrology, Department of Medicine, University of West Virginia School of Medicine, Morgantown, WV, USA. abesarab@pol.net
D001164:Arteriovenous Fistula; D001166:Arteriovenous Shunt, Surgical / Q000592:standards; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D003251:Constriction, Pathologic / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards / Q000639:trends; D017751:Safety Management; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014481:United States; D014654:Vascular Patency