Objective: Arteriovenous fistulas (AVF) constructed before and after initiating the kidney disease outcomes and quality initiative (KDOQI) guidelines were reviewed at a single academic center to identify decreased patency with use of potentially inferior vein conduits. Methods: Primary access procedures performed pre- and post-adoption of KDOQI guidelines were compared for the primary outcomes of maturation rate and primary patency and the secondary outcome of access utilization. Results: The proportion of autologous AVFs created was higher post-KDOQI (73% vs 35%, P < .001), and an increased use of the basilic vein was observed (20% vs 2%, P < .05). The failure rate of fistula maturation was reduced post-KDOQI (24% vs 38%, P < .05); however, access utilization was also decreased (59% vs 75%, P < .001). Conclusions: Adherence to KDOQI guidelines for AVFs does not compromise fistula patency and increased use of the basilic vein may lead to superior fistula maturation rates. Early referral may result in lower fistula utilization rates, however.
Reddan D., Klassen P., Frankenfield DL, et al. National profile of practice patterns for hemodialysis vascular access in the United States. J Am Soc Nephrol. 2002;13(8):2117-2124.
2.
National Kidney Foundation Kidney Disease Outcomes and Quality Initiative (K/DOQI)2006. www.kidney.org. (Accessed August, 2008).
3.
Ascher E., Gade P., Hingorani A., et al. Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg . 2000;31(1 pt 1):84-92.
4.
Rooijens PP, Burgmans JP, Yo TI, et al. Autogenous radial-cephalic or prosthetic brachial-antecubital forearm loop AVF in patients with compromised vessels? A randomized, multicenter study of the patency of primary hemodialysis access. J Vasc Surg. 2005;42(3):481-486; discussions 487.
5.
Tonnessen BH , Money SREmbracing the fistula first national vascular access improvement initiative. J Vasc Surg. 2005; 42(3):585-586.
6.
Woo K., Farber A., Doros G., Killeen K., Kohanzadeh S.Evaluation of the efficacy of the transposed upper arm arteriovenous fistula: a single institutional review of 190 basilic and cephalic vein transposition procedures. J Vasc Surg. 2007;46(1):94-99; discussion 100 .
7.
Coburn MC, Carney WI Jr.Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg. 1994;20(6):896-902; discussion 903-904.
8.
Usrds2006Annual Report: Atlas of ESRD in the US. Paper presented at: National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD; 2006.
9.
Hingorani A. , Ascher E., Kallakuri S., Greenberg S., Khanimov Y.Impact of reintervention for failing upper-extremity arteriovenous autogenous access for hemodialysis. J Vasc Surg . 2001;34(6): 1004-1009.
10.
Association WMDeclaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2000; 284(23):3043-3045.
11.
Patel ST, Hughes J., Mills JL Sr.Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. J Vasc Surg. 2003;38(3):439-445; discussion 445.
12.
Ackad A., Simonian GT, Steel K., et al. A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access. Nephrol Dial Transplant. 2005;20(7):1450-1455.
13.
Schuman E., Standage BA, Ragsdale JW, Heinl P.Achieving vascular access success in the quality outcomes era. Am J Surg. 2004; 187(5):585-589; discussion 589.
14.
McGill RL, Marcus RJ, Healy DA, Brouwer DJ, Smith BC, Sandroni SEAV fistula rates: changing the culture of vascular access. J Vasc Access. 2005;6(1):13-17.
15.
Glazer S., Diesto J., Crooks P., et al. Going beyond the kidney disease outcomes quality initiative: hemodialysis access experience at Kaiser Permanente Southern California. Ann Vasc Surg. 2006;20(1):75-82.
16.
Lok CEFistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol. 2007;2(5):1043-1053.
17.
Lok CE, Allon M., Moist L., Oliver MJ, Shah H., Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol. 2006;17(11):3204-3212.
18.
Ravani P., Barrett B., Mandolfo S., et al. Factors associated with unsuccessful utilization and early failure of the arterio-venous fistula for hemodialysis. J Nephrol . 2005;18(2):188-196.
19.
Biuckians A. , Scott EC, Meier GH, Panneton JM, Glickman MHThe natural history of autologous fistulas as first-time dialysis access in the KDOQI era. J Vasc Surg . 2008;47(2):415-421; discussion 420-421.
20.
Perry HM Jr , Miller JP, Fornoff JR, et al. Early predictors of 15-year end-stage renal disease in hypertensive patients. Hypertension. 1995;25(4 pt 1):587-594.
21.
Barri YMHypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008;10(1):39-45.
22.
Hakaim AG, Nalbandian M., Scott T.Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes. J Vasc Surg. 1998;27(1):154-157.
23.
Wolford HY, Hsu J., Rhodes JM, et al. Outcome after autogenous brachial-basilic upper arm transpositions in the post-National Kidney Foundation Dialysis Outcomes Quality Initiative era. J Vasc Surg. 2005;42(5):951-956.
24.
Silva MB Jr , Hobson RW 2nd, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation . J Vasc Surg. 1998;27(2):302-307; discussion 307-308.
25.
Lauvao LS, Ihnat DM, Goshima KR, Chavez L., Gruessner AC, Mills JL Sr. Vein diameter is the major predictor of fistula maturation. J Vasc Surg.2009;49(6):1499-1504.
26.
Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman-Breen COVascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study . J Vasc Surg. 2001;34(4):694-700.
