Should nephrologists be in charge?
Once, vascular access (VA) for hemodialysis treatment was initiated by nephrologists: Scribner introduced the arteriovenous shunt, Shaldon the central-venous catheters and Brescia-Cimino the arteriovenous fistula. Later on, creating VA became a domain of surgery. Many nephrologists felt out of responsibility. Interventional procedures, angioplasty and stent insertion are mostly performed by radiologists. In 2005, the role of the nephrologist in comprehensive VA care must be newly identified. We know about the value of early referral to nephrologist and access surgeon to preserve venous vasculature. The nephrologist cares for clinical examination of vessels, for an ultrasound Doppler evaluation before the creation of primary VA with clear preference to native arteriovenous fistulae to aim at an early failure rate. Surveillance and monitoring require the exclusive responsibility of the nephrologist and his team. Early diagnosis of VA dysfunction allows elective revision before the onset of thrombosis. There should be an agreement on strategies between nephrology, surgery and radiology. Surgical techniques and skills are to be assessed from time to time. Worldwide, new organizational structures in creation, control and documentation of VA are needed. Flexibility between the disciplines involved as well as educational programs for nephrologists, surgeons and radiologists are future challenges.
Konner
Klaus
K
Department of Internal Medicine I, Cologne General Hospital University of Cologne, Cologne, Germany.
D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling; D006801:Humans; D009398:Nephrology / Q000379:methods*; D010348:Patient Care Team; D010819:Physician's Role; D011159:Population Surveillance; D012017:Referral and Consultation; D006435:Renal Dialysis