Hemodialysis vascular access management in the Netherlands.
OBJECTIVE
In the Netherlands, 86% of patients start renal replacement therapy with chronic intermittent hemodialysis (HD). Guidelines do indicate predialysis care and maintenance of a well-functioning vascular access (VA) as critical issues in the management of the renal failure patient. Referral to the surgeon and time to VA creation are important determinants of the type and success of the VA and HD treatment.


RESULTS
Data from a national questionnaire showed that time from referral to the surgeon and actual access creation is <4 weeks in 43%, 4 to 8 weeks in 30% and >8 weeks in 27% of the centers. Preoperative ultrasonography and postoperative access flowmetry are the diagnostic methods in the majority of centers (98%). Most facilities perform rope-ladder cannulation with occasionally the buttonhole technique for selected patients in 87% of the dialysis units. Endovascular intervention for thrombosis is practiced by 13%, surgical thrombectomy by 21% and either endovascular or surgery by 66% of the centers. Weekly multidisciplinary meetings are organized in 57% of the units. Central vein catheters are inserted by radiologists (36%), nephrologists and surgeons (32%).


CONCLUSIONS
We conclude that guidelines implementation has been successful in particular regarding issues as preoperative patient assessment for VA creation and postoperative surveillance in combination with (preemptive) endovascular intervention, leading to very acceptable VA thrombosis rates.
1 Department of Surgery, Maastricht University Medical Center, Maastricht - The Netherlands.
Jan H M
JH
Tordoir
Magda M
MM
van Loon
Margreet
M
ter Meer
Jorinde
J
van Laanen
Aron S
AS
Bode
Marcel C
MC
Weijmer
Noud
N
Peppelenbosch
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods / Q000592:standards; D061807:Catheter Obstruction / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000592:standards; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome