A dedicated vascular access program can improve arteriovenous fistula rates without increasing catheters.
OBJECTIVE
We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates.


METHODS
A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients.


RESULTS
The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85-0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09-2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85-0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact.


CONCLUSIONS
We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.
Kiaii
M
M
Division of Nephrology, University of British Columbia, Vancouver, Canada.
MacRae
J M
JM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D001955:British Columbia; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D006435:Renal Dialysis; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors