Reducing Catheter Rates
The Dialysis Vascular Access Coalition (DVAC) is fighting to protect the ability for dialysis patients to have the right vascular access. In the early 2000s, most dialysis patients were not getting the right vascular access – with fistula rates well below 40% – and concerns were so pronounced that CMS launched a nationwide Fistula First Breakthrough Initiative (FFBI). By 2017, fistula rates had reached almost 66%, which was the goal set by the original FFBI. (1)
Unfortunately, central venous catheter (CVC) rates remain very high in the United States in patients initiating hemodialysis, exceeding 80% (2). What is worse, recent data shows that there is a general shift away from fistulas with more patients backsliding into the use of a catheter. Data from the United States Renal Data System (USRDS) shows that the percentage of adult dialysis patients on a catheter instead of an arteriovenous access (fistula or graft) has increased to 23.7% with the baseline being 16.7% and the target being 10%. (3)
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Selecting and maintaining an appropriate vascular access is essential to safe hemodialysis. Fistulas are recognized as the best vascular access option for most patients.
AV fistulas have the lowest infection rates, better patency, fewer interventions and less hospitalizations while central venous catheters have the highest infection rates, lower patency and increased hospitalizations according to CDC national surveillance data. Reducing avoidable catheter dependence is therefore an important priority. Fistulas also have the lowest annual total cost of care when compared with catheters and grafts.
Access selection should follow an individualized ESKD Life-Plan that considers the patient’s anatomy, likelihood of successful access use, anticipated dialysis duration, and patient preferences.
(1) Lee T. (2017). Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care. Cardiovascular engineering and technology, 8(3), 244–254. https://doi.org/10.1007/s13239-017-0319-9
(2) Ibid