Approximately 400,000 US patients with kidney failure, or end stage renal disease (ESRD), depend on regular dialysis to survive. Exactly how the dialysis machine is connected to the patient’s blood vessels can make a significant difference in life expectancy and the rate of complications. Thanks to a large and aggressive nationwide program to spread best practices in vascular access, more and more dialysis patients are getting the best evidence-based care. IHI supported this initiative in partnership with the Centers for Medicare and Medicaid Services and the 18 regional ESRD Networks.
Called Fistula First, the initiative seeks to reduce the use of synthetic grafts and catheters, which lead to complications estimated to cost Medicare over $1 billion annually, and increase the rate of arteriovenous (AV) fistula use in hemodialysis patients, which evidence shows reduces mortality and morbidity as well as cost. An AV fistula creates access for the dialysis machine by surgically joining a vein and an artery.
Lawrence Spergel, MD, FACS, Director of the Dialysis Management Medical Group of San Francisco, California, and Clinical Chair of Fistula First, says the challenge is “reversing several decades’ worth of medical practice.” So far, it’s working: In 2001 the rate of fistula use for ongoing (not new) patients was about 31 percent. By August 2005, that rate had risen to 40.1 percent.
01/23/2006
