Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative.
BACKGROUND
In the Netherlands, arteriovenous fistulas (AVFs) are used in 60-65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs.


METHODS
Physicians and dialysis staff in 11 participating centres (N=1092 vascular accesses) were strongly and repeatedly advised to adhere to current guidelines with extra attention for pre-operative duplex examination and salvaging of failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses using an internet-linked database. In 22 other centres (N=1566 accesses), the CIMINO programme was not offered and they were considered the control group.


RESULTS
On 1 January 2006, average follow-up time of the CIMINO group and the control group were 13.3 months and 34.1 months, respectively. A total of 598 new vascular accesses (77% AVFs) were created in the CIMINO group. Prevalent AVF use increased from 58.5% (range: 31-79%) to 62.7% (range: 45-83%) in the CIMINO group and from 65.5% (range: 31-91%) to 67.3% (range: 42-91%) in the control group. The increase in AVF use per year was significantly quicker than in the control group (P<0.05). Use of untunnelled catheters decreased whereas that of tunnelled catheters increased.


CONCLUSIONS
This initiative shows that a multicentre guidelines implementation programme results in an accelerated increase of AVF use in comparison with a time control group. These data suggest that the choice of access placement depends predominantly on centre-specific factors.
Huijbregts
Henricus J T A M
HJ
Department of Nephrology, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Bots
Michiel L
ML
Moll
Frans L
FL
Blankestijn
Peter J
PJ
D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002408:Catheters, Indwelling; D003710:Demography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015995:Prevalence; D006435:Renal Dialysis