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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Balancing Fistula First With Catheters Last
American Journal of Kidney Diseases, Volume 50, No. 3, Year 2007
Notification
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Description
The success of Fistula First nationwide has been accompanied by an unplanned increase in hemodialysis catheters. Complications related to prolonged hemodialysis catheter use include increased morbidity, mortality, and cost. We hypothesize that the national focus on increasing fistulas may have inadvertently diverted attention away from initiatives to decrease dependence on hemodialysis catheters. Based on a synthesis of guidelines, reviews, published evidence, and the authors' opinions, we propose that the national vascular access initiative be revised to have a dual goal of Fistula First and "Catheters Last." These goals are not mutually exclusive, but rather complementary. We recommend a systematic refocus on interventions that not only increase fistulas, but help avoid extended catheter use. Clearly, the ideal practice for hemodialysis vascular access remains early placement of fistulas with enough maturation time such that they can be used for initiating long-term hemodialysis therapy when the need arises. To effect this change, a reimbursement policy covering the costs associated with permanent access placement before the need for dialysis is essential. Individualized patient management strategies may consider such innovative approaches as initiating patients on peritoneal dialysis therapy or using nonautogenous grafts as bridge accesses in lieu of catheters. For patients who are dialyzing using catheters, immediate active planning for permanent access placement and removal of the catheter is necessary. In the same vein as Fistula First, the renal community should once again be galvanized in working together toward controlling the catheter epidemic in our dialysis population. © 2007 National Kidney Foundation, Inc.
Authors & Co-Authors
Lazarus, John Michael
United States, Waltham
Fresenius Medical Care North America
Ikizler, Talat Alp
United States, Nashville
Vanderbilt University Medical Center
Statistics
Citations: 152
Authors: 2
Affiliations: 3
Identifiers
Doi:
10.1053/j.ajkd.2007.06.006
ISSN:
02726386
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study