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Abstract: FR-PO727

Patient Centered Care: The Effect of an Integrated Nephrology-Vascular Surgery-Ultrasound Clinic on Arteriovenous Fistula Use

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Kuo, Teresa, Kaiser Permanente, San Francisco, California, United States
  • Iwasaki, Sumie, Kaiser Permanente , San Francisco, California, United States
  • Lapasia, Jessica B., Kaiser Permanente , San Francisco, California, United States
  • Lyon, Liisa, Kaiser Permanente, San Francisco, California, United States
  • Baker, Aaron C., Kaiser Permanente, San Francisco, California, United States
  • Hua, Hong T., Kaiser Permanente, San Francisco, California, United States
  • Shirazi, Aida, Kaiser Permanente, San Francisco, California, United States
  • Jonelis, Tracy Y., Kaiser Permanente , San Francisco, California, United States
Background

Arteriovenous fistula (AVF) is the preferred form of vascular access for hemodialysis due to their association with lower rates of complication and lower cost of maintenance. Multiple teams are involved throughout the course of AVF creation but they are often not seeing the patient simultaneously. We hypothesize that an integrated, multidisciplinary clinic including nephrologists, vascular surgeons, and an ultrasonographer will improve initiation of hemodialysis using AVF.

Methods

The study population included adults at least 18 years old who received an AVF between March 2013 and March 2016 at Kaiser Permanente San Francisco (KPSF), during which an integrated clinic was formed. This cohort was retrospectively compared to KPSF patients who received an AVF between March 2009 to March 2012. Subjects were excluded if they had a prior AVF placed in the previous 12-24 months, history of renal transplant, death before AVF use, or lost to follow up. The final analytic cohort included 233 patients. Chi-square tests and t-tests were used to compare the demographic (age, race, gender) and clinical characteristics (diabetes mellitus, HbA1c, estimated glomerular filtration rate, peripheral vascular disease, and tobacco smoking status) by integrated vs the non-integrated clinic. Chi-square tests and logistic regression were used to compare clinical outcomes of patients in integrated clinic compared to patients in the non-integrated clinic.

Results

There were 118 patients in the integrated clinic (mean age 70.4±13.7 years, 30.5% women) and 115 patients in the non-integrated clinic (mean age 66.2±13.1 years, 40.9% women). Enrollment in the integrated clinic significantly improved initiation of dialysis using an AVF (48.3% versus 33.9%; odds ratio, OR, 1.8; p=0.03). The integrated clinic also significantly decreased initiation of dialysis using a central venous catheter (CVC) (35.6% versus 51.3%; OR 0.5, p=0.02).

Conclusion

An integrated, multidisciplinary AVF surveillance clinic increases initiation of hemodialysis using AVFs and decreases initiation of hemodialysis using CVCs.