Quality indicators of vascular access procedures for hemodialysis
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NEPHROLOGY - REVIEW
Quality indicators of vascular access procedures for hemodialysis Branko Fila1 Received: 10 May 2020 / Accepted: 12 August 2020 © Springer Nature B.V. 2020
Abstract Improved quality of surgical procedures can minimize complications, the morbidity and mortality of patients, and in addition decrease costs. Quality indicators in angioaccess surgery are, however, not clearly defined. The aim of this review article is therefore to find the most important factors affecting quality in vascular access procedures. Even though autogenous arteriovenous fistula has been recognized as the best vascular access for hemodialysis, the high percentage of unsuccessful attempts associated with it raises the question about quality assessment in angioaccess procedures. Unfortunately, quality indicators in vascular access surgery are difficult to define and measure. Among those that can be obtained are: the time between the presentation of patients to a vascular access surgeon and the construction of a fistula, the percentage of autogenous fistulas, the percentage of functional fistulas in prevalent and incident hemodialysis patients, the percentage of creation of a functional fistula in the first attempt, and durability of an access. Organizational improvement and educational programs are also necessary at institutions with inferior quality indicators of vascular access care, as even small increase in quality may mean the survival of an individual patient. Quality indicators in angioaccess surgery can also serve as a helpful tool in choosing the best vascular access surgeon or vascular access center. The choice can consequently reflect on increased survival and quality of life in patients needing hemodialysis. Keywords Hemodialysis · Vascular access · Quality indicators
Introduction The number of patients being treated for end-stage renal disease (ESRD) globally continues to increase every year at a significantly higher rate than the world population. In Europe, for example, 592,779 prevalent patients were receiving renal replacement therapy (RRT) on 31 December 2017. The main RRT therapy was hemodialysis (HD)—in 57% of the patients—while peritoneal dialysis was used in 5% of patients, and 37% had a functional kidney transplant [1]. Treating ESRD patients requires a huge amount of resources from national public and private funds [2]. Autogenous arteriovenous fistula (AVF) is designated as the best available vascular access (VA) for HD [3–5]. A lower overall cost is precisely one of the advantages of AVF when compared to the cost of arteriovenous grafts (AVGs) or central venous catheters (CVCs) [6]. Guidelines and initiatives * Branko Fila [email protected] 1
Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
recommend the construction of an AVF as the first choice whenever possible. The ultimate goal of angioaccess surgery is a functional, durable access with a low complications rate [7, 8]. As a downside, the creation of a functional AVF is hampered
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