Quality Improvement
Fistula First
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AV Fistula Prevalence by Network - 2001
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Dialysis patients and the medical professionals who care for them recognize that vascular access is the patient's "lifeline." Having a successful access is a major contributor to patient well-being; conversely, access problems are seen as the major cause of illness and disability for those on dialysis.

While substantial progress has been made on key indicators of dialysis quality such as dialysis adequacy (Kt/V), vascular access continues to present significant challenges. It is an important determinant of dialysis adequacy and has significant implications for morbidity-related outcomes such as infection and mortality rates with higher mortality noted among patients using AV grafts and catheters for long-term dialysis.

Among those responsible for the care of hemodialysis patients, there is agreement that the preferred type of vascular access is a native arterial-venous fistula (AVF). Compared to catheters and arterial venous grafts, native AVFs show significantly lower rates of complication (such as infection and clotting), longer patency, fewer hospitalizations, lower patient morbidity and significantly lower costs.

The desirability of the AVF is reflected in the CMS ESRD Clinical Performance Measures (CPM) project:
A primary arterial venous fistula (AVF) should be the access for at least 50% of all new patients initiating hemodialysis. A native AVF should be the primary access for 40% of all prevalent patients undergoing hemodialysis.

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Goal

The United States renal care system as a whole will make significant progress toward attaining CPM and K/DOQI goals for AVF use (50% incident cases; 40% prevalent cases) by June 2006.


Mission Statement

CMS, the ESRD Networks, the renal community, and Institute for Healthcare Improvement (IHI) will work together to increase the likelihood that every eligible patient will receive the most optimal form of vascular access for that patient (in the majority of cases an arterial venous fistula), and that vascular access complications will be avoided through appropriate access monitoring and intervention.

CMS has committed to a system-wide improvement project on vascular access to achieve regional and national AVF rates of 50% or greater for incident patients, and at least 40% for prevalent patients undergoing hemodialysis by 2006.

The project will bring together the best of what is known about improving vascular access across the United States and the Islands. By harnessing the knowledge of the many disciplines whose care influences vascular access choices for patients, all will work to create a new level of cooperation across professional disciplines and care settings.

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Information and Instructions
National Kidney Foundation vascular access guidelines. K/DOQI is an initiative of the National Kidney Foundation that has led to a comprehensive set of practice guidelines for a wide range of dialysis care processes, including vascular access.

NKF-DOQI Guidelines Summary

ESRD resources:

  • Patient Resources Fistula First Project
  • Patient Resources for Vascular Access Education

Patient education materials to improve vascular access outcomes: