UK organisation of access care.
National UK audits show that 73% of patients start renal replacement therapy (RRT) with haemodialysis (HD). However, 59% of those start HD on non-permanent access in the form of a tunnelled line (TL) or a non-tunnelled line (NTL), 40% on an arteriovenous fistula (AVF) and 1% on an arteriovenous graft (AVG). After 3 months, the number of patients dialysing on AVF was only 41%. Late referrals, within 90 days of starting dialysis to the renal service, occur in one-fifth of all incident HD patients. Referral to a surgeon was an important determinant of mode of access at first dialysis. However, referral to a surgeon occurred in 67% of patients who were known to the nephrologist for over a year and in 46% of patients who were known to nephrology less than a year but more than 90 days. Best practice tariffs of the National Health Service (NHS) payment by results program have set a target of 75% of prevalent HD occurring via an AVF or AVG in 2011/2012, rising to 85% in 2013/2014. We suggest that this target is best achieved by increasing timely referral to a surgeon for creation of access before HD is needed.
Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham - UK.
Teun
T
Wilmink
Sarah
S
Powers
Jyoti
J
Baharani
D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000639:trends; D019985:Benchmarking; D002405:Catheterization, Central Venous / Q000639:trends; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017146:Models, Organizational; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D015995:Prevalence; D012017:Referral and Consultation; D012042:Registries; D006435:Renal Dialysis / Q000639:trends; D012111:Residence Characteristics; D013222:State Medicine / Q000458:organization & administration* / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology