- Title
- Barriers to timely arteriovenous fistula creation: a study of providers and patients
- Creator
- Lopez-Vargas, Pamela A.; Craig, Jonathan C.; Thein, Hla; McDonald, Stephen P.; Russell, Christin; Polkinghorne, Kevan R.; Gallagher, Martin P.; Walker, Rowan G.; Snelling, Paul L.; Pedagogos, Eugenia; Gray, Nicholas A.; Divi, Murthy D.; Gillies, Alastair H.; Suranyi, Michael G.
- Relation
- American Journal of Kidney Diseases Vol. 57, Issue 6, p. 873-882
- Publisher Link
- http://dx.doi.org/10.1053/j.ajkd.2010.12.020
- Publisher
- W. B. Saunders
- Resource Type
- journal article
- Date
- 2011
- Description
- Background: Current clinical practice guidelines recommend a native arteriovenous fistula (AVF) as the vascular access of first choice. Despite this, most patients in western countries start hemodialysis therapy using a catheter. Little is known regarding specific physician and system characteristics that may be responsible for delays in permanent access creation. Study Design: Multicenter cohort study using mixed methods; qualitative and quantitative analysis. Setting & Participants: 9 nephrology centers in Australia and New Zealand, including 319 adult incident hemodialysis patients. Predictor: Identification of barriers and enablers to AVF placement. Outcomes: Type of vascular access used at the start of hemodialysis therapy. Measurements: Prospective data collection included data concerning predialysis education, interviews of center staff, referral times, and estimated glomerular filtration rate (eGFR) at AVF creation and dialysis therapy start. Results: 319 patients started hemodialysis therapy during the 6-month period, 39% with an AVF and 59% with a catheter. Perceived barriers to access creation included lack of formal policies for patient referral, long wait times for surgical review and access placement, and lack of a patient database for management purposes. eGFR thresholds at referral for and creation of vascular accesses were considerably lower than appreciated (in both cases, median eGFR of 7 mL/min/1.73 m²), with median wait times for access creation of only 3.7 weeks. First assessment by a nephrologist less than 12 months before dialysis therapy start was an independent predictor of catheter use (OR, 8.71; P < 0.001). Characteristics of the best performing centers included the presence of a formalized predialysis pathway with a centralized patient database and low nephrologist and surgeon to patient ratios. Limitations: A limited number of patient-based barriers was assessed. Cross-sectional data only. Conclusions: A formalized predialysis pathway including patient education and eGFR thresholds for access placement is associated with improved permanent vascular access placement.
- Subject
- barriers; arteriovenous fistula; late referrals; estimated glomerular filtration rate (eGFR); waiting times
- Identifier
- http://hdl.handle.net/1959.13/1065672
- Identifier
- uon:17920
- Identifier
- ISSN:0272-6386
- Language
- eng
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