First hemodialysis access selection varies with patient acuity
Timely placement of a reliable permanent vascular access is essential for hemodialysis care quality; National Kidney Foundation Dialysis Outcomes Quality Improvement (NKF-DOQI) guidelines emphasize native arterio-venous (AV) fistulae as preferred access for incident patients. As part of Network One&...
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| Veröffentlicht in: | Advances in renal replacement therapy 2000-10, Vol.7 (4 Suppl 1), p.S4-10 |
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| container_title | Advances in renal replacement therapy |
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| creator | Friedman, A L Walworth, C Meehan, C Wander, H Shemin, D DeSoi, W Kitsen, J Hill, C Lambert, C Mesler, D |
| description | Timely placement of a reliable permanent vascular access is essential for hemodialysis care quality; National Kidney Foundation Dialysis Outcomes Quality Improvement (NKF-DOQI) guidelines emphasize native arterio-venous (AV) fistulae as preferred access for incident patients. As part of Network One's Vascular Access Quality Improvement Project (QIP) we investigated whether patients' course to end-stage renal disease (ESRD) influenced vascular access selection. Baseline information was obtained for incident (1998) dialysis patients from 6 centers participating in the Network QIP. Patients were subdivided into 3 predefined clinical groups: KNOWN (known chronic renal disease, seen by a nephrologist, with predictable progression to ESRD), CRISIS (KNOWN but with unanticipated medical crisis precipitating ESRD), and UNKNOWN (not known to have chronic renal insufficiency or never seen by a nephrologist before developing ESRD). Two hundred forty patients were identified (median age 69.9, 42% diabetic). Only 43% of the entire population experienced an orderly progression to renal insufficiency. The most frequent initial access was a catheter (54%), followed by a fistula (29%) and a graft (16%), but selection of initial access differed significantly by patient group, with 46% of KNOWN patients receiving a fistula (P |
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As part of Network One's Vascular Access Quality Improvement Project (QIP) we investigated whether patients' course to end-stage renal disease (ESRD) influenced vascular access selection. Baseline information was obtained for incident (1998) dialysis patients from 6 centers participating in the Network QIP. Patients were subdivided into 3 predefined clinical groups: KNOWN (known chronic renal disease, seen by a nephrologist, with predictable progression to ESRD), CRISIS (KNOWN but with unanticipated medical crisis precipitating ESRD), and UNKNOWN (not known to have chronic renal insufficiency or never seen by a nephrologist before developing ESRD). Two hundred forty patients were identified (median age 69.9, 42% diabetic). Only 43% of the entire population experienced an orderly progression to renal insufficiency. The most frequent initial access was a catheter (54%), followed by a fistula (29%) and a graft (16%), but selection of initial access differed significantly by patient group, with 46% of KNOWN patients receiving a fistula (P <.001). After 2 months of dialysis, the initial access supported dialysis in only 53.7% of the KNOWN patients, and in 59.4% and 45.7% of the CRISIS and UNKNOWN patients, respectively. We conclude that unpredicted, new ESRD patients are common and are less likely to receive a fistula as initial hemodialysis access. Studies should define optimum access management when dialysis requirement is unforeseen.</description><identifier>ISSN: 1073-4449</identifier><identifier>PMID: 11053581</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Kidney Injury - etiology ; Acute Kidney Injury - physiopathology ; Acute Kidney Injury - therapy ; Aged ; Arteriovenous Shunt, Surgical - statistics & numerical data ; Blood Vessel Prosthesis ; Catheters, Indwelling - statistics & numerical data ; Centers for Medicare and Medicaid Services (U.S.) ; Female ; Humans ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - therapy ; Male ; Middle Aged ; Patient Selection ; Renal Dialysis ; Severity of Illness Index ; Total Quality Management ; United States</subject><ispartof>Advances in renal replacement therapy, 2000-10, Vol.7 (4 Suppl 1), p.S4-10</ispartof><rights>Copyright 2000 by the National Kidney Foundation, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11053581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Friedman, A L</creatorcontrib><creatorcontrib>Walworth, C</creatorcontrib><creatorcontrib>Meehan, C</creatorcontrib><creatorcontrib>Wander, H</creatorcontrib><creatorcontrib>Shemin, D</creatorcontrib><creatorcontrib>DeSoi, W</creatorcontrib><creatorcontrib>Kitsen, J</creatorcontrib><creatorcontrib>Hill, C</creatorcontrib><creatorcontrib>Lambert, C</creatorcontrib><creatorcontrib>Mesler, D</creatorcontrib><title>First hemodialysis access selection varies with patient acuity</title><title>Advances in renal replacement therapy</title><addtitle>Adv Ren Replace Ther</addtitle><description>Timely placement of a reliable permanent vascular access is essential for hemodialysis care quality; National Kidney Foundation Dialysis Outcomes Quality Improvement (NKF-DOQI) guidelines emphasize native arterio-venous (AV) fistulae as preferred access for incident patients. As part of Network One's Vascular Access Quality Improvement Project (QIP) we investigated whether patients' course to end-stage renal disease (ESRD) influenced vascular access selection. Baseline information was obtained for incident (1998) dialysis patients from 6 centers participating in the Network QIP. Patients were subdivided into 3 predefined clinical groups: KNOWN (known chronic renal disease, seen by a nephrologist, with predictable progression to ESRD), CRISIS (KNOWN but with unanticipated medical crisis precipitating ESRD), and UNKNOWN (not known to have chronic renal insufficiency or never seen by a nephrologist before developing ESRD). Two hundred forty patients were identified (median age 69.9, 42% diabetic). Only 43% of the entire population experienced an orderly progression to renal insufficiency. The most frequent initial access was a catheter (54%), followed by a fistula (29%) and a graft (16%), but selection of initial access differed significantly by patient group, with 46% of KNOWN patients receiving a fistula (P <.001). After 2 months of dialysis, the initial access supported dialysis in only 53.7% of the KNOWN patients, and in 59.4% and 45.7% of the CRISIS and UNKNOWN patients, respectively. We conclude that unpredicted, new ESRD patients are common and are less likely to receive a fistula as initial hemodialysis access. Studies should define optimum access management when dialysis requirement is unforeseen.</description><subject>Acute Kidney Injury - etiology</subject><subject>Acute Kidney Injury - physiopathology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Aged</subject><subject>Arteriovenous Shunt, Surgical - statistics & numerical data</subject><subject>Blood Vessel Prosthesis</subject><subject>Catheters, Indwelling - statistics & numerical data</subject><subject>Centers for Medicare and Medicaid Services (U.S.)</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Renal Dialysis</subject><subject>Severity of Illness Index</subject><subject>Total Quality Management</subject><subject>United States</subject><issn>1073-4449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1z01Lw0AUheFZKLZW_4LMyl1gviezEaRYFQpudB1uJjd0JF_mTpT-ewvW1dk8HHgv2FoKrwtjTFixa6JPIaTyLlyxlZTCalvKNXvYpZkyP2A_Ngm6IyXiECMSccIOY07jwL9hTkj8J-UDnyAnHPIJLSkfb9hlCx3h7Xk37GP39L59KfZvz6_bx30xKRFyUSpVxrpGay0YdNEJY6BRJpZGgEfdYiu1Dt5AiahciBhEQCVlUCq41usNu__7nebxa0HKVZ8oYtfBgONClVfaWanFCd6d4VL32FTTnHqYj9V_sf4FPYxRCw</recordid><startdate>20001001</startdate><enddate>20001001</enddate><creator>Friedman, A L</creator><creator>Walworth, C</creator><creator>Meehan, C</creator><creator>Wander, H</creator><creator>Shemin, D</creator><creator>DeSoi, W</creator><creator>Kitsen, J</creator><creator>Hill, C</creator><creator>Lambert, C</creator><creator>Mesler, D</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20001001</creationdate><title>First hemodialysis access selection varies with patient acuity</title><author>Friedman, A L ; 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National Kidney Foundation Dialysis Outcomes Quality Improvement (NKF-DOQI) guidelines emphasize native arterio-venous (AV) fistulae as preferred access for incident patients. As part of Network One's Vascular Access Quality Improvement Project (QIP) we investigated whether patients' course to end-stage renal disease (ESRD) influenced vascular access selection. Baseline information was obtained for incident (1998) dialysis patients from 6 centers participating in the Network QIP. Patients were subdivided into 3 predefined clinical groups: KNOWN (known chronic renal disease, seen by a nephrologist, with predictable progression to ESRD), CRISIS (KNOWN but with unanticipated medical crisis precipitating ESRD), and UNKNOWN (not known to have chronic renal insufficiency or never seen by a nephrologist before developing ESRD). Two hundred forty patients were identified (median age 69.9, 42% diabetic). Only 43% of the entire population experienced an orderly progression to renal insufficiency. The most frequent initial access was a catheter (54%), followed by a fistula (29%) and a graft (16%), but selection of initial access differed significantly by patient group, with 46% of KNOWN patients receiving a fistula (P <.001). After 2 months of dialysis, the initial access supported dialysis in only 53.7% of the KNOWN patients, and in 59.4% and 45.7% of the CRISIS and UNKNOWN patients, respectively. We conclude that unpredicted, new ESRD patients are common and are less likely to receive a fistula as initial hemodialysis access. Studies should define optimum access management when dialysis requirement is unforeseen.</abstract><cop>United States</cop><pmid>11053581</pmid></addata></record> |
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| subjects | Acute Kidney Injury - etiology Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Aged Arteriovenous Shunt, Surgical - statistics & numerical data Blood Vessel Prosthesis Catheters, Indwelling - statistics & numerical data Centers for Medicare and Medicaid Services (U.S.) Female Humans Kidney Failure, Chronic - etiology Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Male Middle Aged Patient Selection Renal Dialysis Severity of Illness Index Total Quality Management United States |
| title | First hemodialysis access selection varies with patient acuity |
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