Associations with predialysis vascular access management.
BACKGROUND
The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines encourage increasing the proportion of arteriovenous fistulae among incident hemodialysis patients. Achieving optimal outcomes requires predialysis out-patient follow-up by a nephrologist, predialysis placement of a vascular access, and adequate maturation of the vascular access.


METHODS
We assessed the effect of clinical factors on predialysis vascular access management in all incident hemodialysis patients at a single institution during a 2-year period.


RESULTS
Of 157 patients initiating dialysis therapy from January 1, 2001, to December 31, 2002, a total of 73.2% had predialysis follow-up by a nephrologist, 46.5% had predialysis vascular access surgery, and 35.0% initiated their first dialysis session with a permanent access. Among patients using a permanent access on their first dialysis session, 67.3% used a fistula. Patients with diabetes were more likely than those without diabetes to have predialysis nephrology follow-up (81.5% versus 61.5%; P = 0.005), undergo predialysis vascular access surgery (56.5% versus 32.3%; P = 0.003), and initiate their first dialysis session with a fistula or graft (43.5% versus 23.1%; P = 0.008). Duration of predialysis nephrology follow-up was similar between patients with and without diabetes (median, 412 versus 300 days; P = 0.27). Patient age, sex, and race were not predictive of predialysis access management.


CONCLUSIONS
Despite attempts to follow the K/DOQI guidelines, 65% of incident hemodialysis patients initiated their first dialysis treatment with a catheter. Patients with diabetes were significantly more likely to have predialysis follow-up by a nephrologist and thus more likely to initiate their first dialysis session with a permanent access. Emphasis on early referral of patients with chronic kidney disease without diabetes to nephrologists may increase fistula use among incident hemodialysis patients.
Lee
Timmy
T
Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
Barker
Jill
J
Allon
Michael
M
D001166:Arteriovenous Shunt, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000379:methods / Q000706:statistics & numerical data*; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D006435:Renal Dialysis / Q000379:methods*