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Kidney Week

Abstract: PO1326

Implementing Multidisciplinary Pre-ESRD Program to Improve Vascular Access in New-Start Dialysis Patients

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Jobalia, Nathan K., Santa Clara Valley Medical Center, San Jose, California, United States
  • Sirich, Tammy L., Stanford University School of Medicine, Stanford, California, United States
  • Nguyen, Vy Dang, Santa Clara Valley Medical Center, San Jose, California, United States
  • Pham, Nhat M., Santa Clara Valley Medical Center, San Jose, California, United States
Background

Tunneled dialysis catheters (TDC’s) are associated with morbidity and mortality in dialysis patients. In the U.S., more than 80% of patients start dialysis with a TDC and even higher rates for ethnic minorities. As part of the Santa Clara County healthcare system, we care for an underserved population, predominately of ethnic minorities. To reduce our TDC rates, we implemented a Pre-ESRD program that encompasses a multidisciplinary team, EMR tracking, access referral guidelines, and culturally relevant patient education. We assessed whether this program reduced the proportion of patients starting dialysis with a TDC and no other vascular access (TDC-Only).

Methods

We performed a retrospective chart review of new start dialysis patients in 2014 (before program implementation) and in 2017 (after program implementation). Patients must have been seen in renal clinic for at least 3 months before starting dialysis. We compared the proportion of TDC-Only between the two groups using the Chi-Square Test. We also compared the type of vascular access placed between the two groups.

Results

87 patients started dialysis in 2014 and in 2017. There was no difference in age (58 vs 56 years) or diabetes (61% vs 70%) between the two groups. The two groups consisted mostly of minorities (Hispanic: 52% vs 55%, Asian: 31% vs 26%, Black: 7% vs 3%, and White: 10% vs 14%) and non-English speakers (44% vs 46%). The type of access at dialysis start is summarized in the table.

The proportion of TDC-Only reduced by 21% after program implementation but did not reach statistical significance: 62% of patients started with TDC-Only in 2014 compared to 49% in 2017 (p=0.09). In addition, AVF placement more than doubled after program implementation (19% vs 42%, p=0.001).

Conclusion

Implementation of a multidisciplinary Pre-ESRD program reduced the number of TDC-Only and increased the number of AVF’s in new dialysis start patients. Our study is unique due to our patient population of predominantly minorities and non-English speakers.

Initial Vascular Access
 2014 (n=87) 2017 (n=87) 
TDC-Only5462%4349%
TDC w/ Other Access33%1113%
AVF1517%2529%
AVG56%22%
PD1011%67%