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Abstract: TH-OR144

Patient, Care Partner, and Provider Perspectives on Arteriovenous (AV) Access Creation Prior to Hemodialysis (HD) Initiation

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access


  • Manivannan, Surya, university of north carolina, Chapel Hill, North Carolina, United States
  • Narendra, Julia, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Murphy, Shannon L., University of North Carolina, Chapel Hill, North Carolina, United States
  • Yule, Christina, Geisinger Health System, Danville, Pennsylvania, United States
  • Bonaparte, Heather, Geisinger, Danville, Pennsylvania, United States
  • Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States
  • Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Flythe, Jennifer E., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States

More than 80% of individuals in the U.S. start maintenance HD with a catheter, despite substantial evidence that starting HD with an AV access improves quality of life, lowers mortality, and decreases healthcare costs. Barriers to AV access creation prior to HD initiation have been under-investigated. We sought to identify patient, care partner, medical provider, and clinic personnel perspectives on the AV access creation process in the pre-HD period.


We conducted 4 focus groups (N=24 participants) and 16 semi-structured interviews across 2 diverse health systems (UNC and GH). Focus groups included advanced chronic kidney disease patients (GFR <20 mL/min/1.73m2), and separately, HD patients within 1 year of HD initiation as well as care partners of such patients. Interviewees included nephrologists, surgeons, clinic nurses, imaging specialists, and other staff. Transcripts were coded independently by 3 researchers and thematically analyzed.


Participants identified a range of patient- and healthcare system-related barriers to starting HD with an AV access. Key modifiable barriers included: siloed provider views of the AV access creation process; negative patient emotions (e.g. fear, denial, uncertainty); inadequate and inconsistent patient education; and lack of systematic approaches to tracking patients through AV access care processes. Key facilitators included: early and sustained dedicated vascular access education (i.e. separate from modality and transplant education); care partner inclusion in education; and positive peer interactions. Participants identified 4 essential aspects of pre-HD vascular access care: strong patient—provider relationships (trust, shared decision-making); focused, iterative multi-format education; peer support; and assistance in process navigation (e.g. care navigation, vascular access-specific electronic health record reports, consistent provider communication).


Programs aimed at improving rates of HD initiation with an AV access must address both patient- and healthcare system-related barriers. Key components include strong patient-provider relationships, targeted education, peer support, and care navigation.


  • NIDDK Support