Abstract: FR-PO777
Optimal ESRD Starts as an Organizational Metric Enabling Reduction in CVC Use
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Pravoverov, Leonid, Kaiser Permanente, Walnut Creek, California, United States
- Zheng, Sijie, The Permanente Medical Group, Oakland, California, United States
- Mroz, Joanna, The Permanente Medical Group, Oakland, California, United States
Background
Patients who initiate dialysis with central venous catheters are associated with higher rate of infection, death and hospitalization. However in the United States, on average 80% of patients started hemodialysis are using central venous catheter instead of a matured AVF/AVG. Kaiser Permanente Northern California (KPNC) is an integrated health care system of 4 million members with an average of 1300 patients starting renal replacement therapy every year. Through a systemic multi-discipline approach, KPNC was able to gradually increase patients with and “optimal start” to 67% and reduce incident patients using CVC to initiate dialysis to 33%.
Methods
Since 2009 KPNC adopted Optimal ESRD Starts metric, targeting to (1) increase use of home dialysis modalities, Peritoneal Dialysis (PD) and home hemodialysis (HHD), (2) increase use of AVF/AVG in hemodialysis population and (3) increase number of pre-emptive transplants.
Results
Throughout systematic approach and advantages of integrated healthcare system, we are able to reduce use of CVC as an initial access for dialysis to less than 33%.
Conclusion
It is feasible to decrease CVC in patients starting renal replacement therapy by systemic and multi-disciplinary approach.