Hemodialysis access success: beyond the operating room.
BACKGROUND
Publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines has reinforced an already increased focus within the Veterans Health Administration (VHA) on arteriovenous (AV) hemodialysis (HD) vascular access. Meeting these KDOQI goals has been the responsibility of individual VHA centers. We responded by organizing a dedicated HD AV clinic to provide preoperative evaluation and postoperative follow-up.


METHODS
The records of 130 patients referred from January 2004 through June 2006 to our AV HD clinic were retrospectively reviewed. A minimum of 6 months of postoperative follow-up was required.


RESULTS
AV fistulae were performed in 71% of the patients, with approximately 45% being Brescia-Cimino fistulae. Importantly, only 38% of AV fistulae matured and were used without secondary intervention. The remaining 62% of AV fistulae each required 2.2 +/- .3 interventions. The final AV fistula use rate was approximately 85%.


CONCLUSIONS
To meet these KDOQI guidelines, the VHA should continue to support the concept of dedicated AV HD teams and clinics. This is essential because the majority of our new AV fistulae required secondary intervention for AV fistulae maturation and use. A dedicated HD access team should better be able to assess AV fistula maturation and organize subsequent intervention to promote AV fistulae use.
Barone
Gary W
GW
Surgery Service, Central Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, USA. baronegary@uams.edu
Wright
Candace F
CF
Krause
Michelle W
MW
Brosnahan
Godela M
GM
Portilla
Didier
D
Banerjee
Satyaki
S
McCowan
Timothy C
TC
Culp
William C
WC
Yousaf
Muhammad
M
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies