Why Do So Many Patients Have a Dialysis Catheter and Not Arteriovenous Fistulae or Grafts?
Abstract:The Dialysis Outcome and Quality Initiative has guidelines for vascular access and states that the dialysis catheter (DC) should be limited to less than 20% of the end-stage renal disease (ESRD) patients. Our center has found this target difficult to achieve. Objective:
We wondered what the reasons for use of a DC might be. Methods:
We noted the number of patients with a DC in place and assessed the reasons why the DC was being used on 8/1/03. Results:
73 of the 170 (42.9%) patients had a DC on 8/1/03. 24 (32.9%) of the patients refused to have initial arteriovenous fistulae or grafts (AVF/G) or a secondary AVF/G revision or replacement procedure performed after initial AVF/G failure. 15 (20.5%) patients had a maturing AVF/G, 12 (16.4%) had significant medical and/or surgical contraindications for AVF/G placement, 9 (12.3%) patients were awaiting surgical thrombectomy, revision or placement of AVF/G, 6 patients (8.2%) were awaiting transfer to CPD therapy, 4 (5.5%) patients were undecided about having an AVF/G placed, and 1 (1.4%) had acute renal failure and early ESRD recovery was expected. Only 2 (2.7%) patients had no access plan by the nephrology team. Conclusions:
Patients' refusal for an AVF/G placement and patients with a maturing AVF/G or awaiting surgical revision or placement were the most common reasons for the use of a DC in our center. To significantly impact on the high use of the DC, it would be crucial to better understand the reasons for patients’ refusals.
Document Type: Research Article
Affiliations: Renal Research Institute, New Haven, CT, U.S.A.
Publication date: January 1, 2004