title: Vascular access care and treatment practices associated with outcomes of arteriovenous fistula: international comparisons from the Dialysis Outcomes and Practice Patterns Study.
abstract: BACKGROUND
  Vascular access (VA) guidelines recommend the native arteriovenous fistula (AVF) as VA of first choice for chronic hemodialysis patients. AVF management is important in hemodialysis patient care. AVF survival is associated with various physical factors, but the effects of dialysis treatment factors upon AVF survival are still not clear.
  
  
  METHODS
  Study patients were treated at 498 dialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 or 3 (2002-2007). Analyses included 1,183 incident hemodialysis patients (on dialysis ≤7 days and using an AVF at study entry) and 949 prevalent patients (on dialysis >7 days at DOPPS entry and using a new AVF created during study observation). AVF survival was modeled from the study entry date for incident patients and date of first AVF use for prevalent patients. Predictors of primary and final AVF survival were compared across Japan, North America and Europe/Australia/New Zealand (EUR/ANZ) with adjustments for patient characteristics.
  
  
  RESULTS
  No meaningful relationship was seen between AVF survival and various physician and staff practices. However, patients with prior catheter use displayed higher rates of primary and final AVF failure. Final AVF failure rates were higher in facilities with higher median blood flow rates (BFR). They were also greater in North America and EUR/ANZ than in Japan, but this difference was substantially attenuated after accounting for regional differences in facility median BFR.
  
  
  CONCLUSIONS
  AVF longevity differed according to the DOPPS region, and was related to prior patient catheter use and facility BFR practice. Further longitudinal studies may help demonstrate meaningful associations between VA-handling skill and patency.
authors.affiliation: Renal Unit, Ikegami General Hospital, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Asano
authors.forename: Jyothi
authors.initials: J
authors.lastname: Thumma
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oguchi
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Jean
authors.initials: J
authors.lastname: Ethier
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D062666:Vascular Access Devices