Multi-Disciplinary Vascular Access Care and Access Outcomes in People Starting Hemodialysis Therapy

Clinical journal of the American Society of Nephrology: CJASN

Daniel Devoe¹  Braden Manns²  Simardeep Gill²  Robert Quinn³  Rameez Kabani⁶ 

[1] and..Departments of *Medicine and..;Departments of *Medicine and..;Departments of *Medicine and..†Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;§Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada..§Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada..Departments of *Medicine and..;†Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;‡Department of Medicine, University of Toronto, Toronto, Ontario, Canada

关键词: arteriovenous fistula;    vascular access;    Central Venous Catheters;    hemodialysis;    Aged;    Odds Ratio;    Logistic Models;    Confidence Intervals;    Comorbidity;    renal dialysis;    Probability;    Surgeons;    diabetes mellitus;    Radiologists;    Fistula;    Canada;   

DOI  :  10.2215/CJN.03430317

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Fistulas, the preferred form of hemodialysis access, are difficult to establish and maintain. We examined the effect of a multidisciplinary vascular access team, including nurses, surgeons, and radiologists, on the probability of using a fistula catheter-free, and rates of access-related procedures in incident patients receiving hemodialysis.Design, setting, participants, & measurements We examined vascular access outcomes in the first year of hemodialysis treatment before (2004–2005, preteam period) and after the implementation of an access team (2006–2008, early-team period; 2009–2011, late-team period) in the Calgary Health Region, Canada. We used logistic regression to study the probability of fistula creation and the probability of catheter-free fistula use, and negative binomial regression to study access-related procedure rates.Results We included 609 adults (mean age, 65 [±15] years; 61% men; 54% with diabetes). By the end of the first year of hemodialysis, 102 participants received a fistula in the preteam period (70%), 196 (78%) in the early-team period (odds ratios versus preteam, 1.47; 95% confidence interval, 0.92 to 2.35), and 139 (66%) in the late-team period (0.85; 0.54 to 1.35). Access team implementation did not affect the probability of catheter-free use of the fistula (odds ratio, 0.87; 95% confidence interval, 0.52 to 1.43, for the early; and 0.89; 0.52 to 1.53, for the late team versus preteam period). Participants underwent an average of 4–5 total access-related procedures during the first year of hemodialysis, with higher rates in women and in people with comorbidities. Catheter-related procedure rates were similar before and after team implementation; relative to the preteam period, fistula-related procedure rates were 40% (20%–60%) and 30% (10%–50%) higher in the early-team and late-team periods, respectively.Conclusion Introduction of a multidisciplinary access team did not increase the probability of catheter-free fistula use, but resulted in higher rates of fistula-related procedures.

【 授权许可】

CC BY