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Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care

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Abstract

The vascular access is the lifeline for the hemodialysis patient. In the United States, the Fistula First Breakthrough Initiative (FFBI) has been influential in improving use of arteriovenous fistulas (AVF) in prevalent hemodialysis patients. Currently, prevalent AVF rates are near the goal of 66% set forth by the original FFBI. However, central venous catheter (CVC) rates remain very high in the United States in patients initiating hemodialysis, nearly exceeding 80%. A new direction of the of the FFBI has focused on strategies to reduce CVC use, and subsequently the FFBI has now been renamed the “Fistula First-Catheter Last Initiative”. However, an AVF may not be the best vascular access in all hemodialysis patients, and arteriovenous grafts (AVG) and CVCs may be appropriate and the best access for a subset of hemodialysis patients. Unfortunately, there still remains very little emphasis within vascular access initiatives and guidelines directed towards evaluation of the individual patient context, specifically patients with poor long-term prognoses and short life expectancies, patients with multiple comorbidities, patients who are more likely to die than reach end stage renal disease (ESRD), and patients of elderly age with impaired physical and cognitive function. Given the complexity of medical and social issues in advanced CKD and ESRD patients, planning, selection, and placement of the most appropriate vascular access are ideally managed within a multidisciplinary setting and requires consideration of several factors including national vascular access guidelines. Thus, the evolution of the FFBI should underscore the need for multidisciplinary health teams with a major emphasis placed on “the right access for the right patient” and improving the patient’s overall quality of life.

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References

  1. Afsar, B., et al. Vascular access type, health-related quality of life, and depression in hemodialysis patients: a preliminary report. J. Vasc. Access 13(2):215–220, 2012.

    Google Scholar 

  2. Agarwal, A. K. Central vein stenosis. Am. J. Kidney Dis. 61(6):1001–1015, 2013.

    Google Scholar 

  3. Agarwal, A. K., N. J. Haddad, and H. Khabiri. How should symptomatic central vein stenosis be managed in hemodialysis patients? Semin. Dial 27(3):278–281, 2014.

    Google Scholar 

  4. Allon, M., et al. A multidisciplinary approach to hemodialysis access: prospective evaluation. Kidney Int. 53(2):473–479, 1998.

    Google Scholar 

  5. Allon, M., et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int. 60(5):2013–2020, 2001.

    Google Scholar 

  6. Allon, M., et al. Effect of change in vascular access on patient mortality in hemodialysis patients. Am. J. Kidney Dis. 47(3):469–477, 2006.

    Google Scholar 

  7. Allon, M. Current management of vascular access. Clin. J. Am. Soc. Nephrol. 2(4):786–800, 2007.

    MathSciNet  Google Scholar 

  8. Allon, M. Fistula first: recent progress and ongoing challenges. Am. J. Kidney Dis. 57(1):3–6, 2011.

    Google Scholar 

  9. Allon, M., and M. L. Robbin. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 62(4):1109–1124, 2002.

    Google Scholar 

  10. Asif, A., et al. Interventional nephrology: from episodic to coordinated vascular access care. J. Nephrol. 20(4):399–405, 2007.

    Google Scholar 

  11. Astor, B. C., et al. Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. Am. J. Kidney Dis. 38(3):494–501, 2001.

    Google Scholar 

  12. Astor, B. C., et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J. Am. Soc. Nephrol. 16(5):1449–1455, 2005.

    Google Scholar 

  13. Baker, Jr, L. D., J. M. Johnson, and D. Goldfarb. Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Trans. Am. Soc. Artif. Intern. Organs. 22:382–387, 1976.

    Google Scholar 

  14. Bay, W. H., S. Van Cleef, and M. Owens. The hemodialysis access: preferences and concerns of patients, dialysis nurses and technicians, and physicians. Am. J. Nephrol. 18(5):379–383, 1998.

    Google Scholar 

  15. Beathard, G. A. Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care. Kidney Res. Clin. Pract. 34(3):125–131, 2015.

    Google Scholar 

  16. Beathard, G. A., T. Litchfield, and I. Physician Operators Forum of Rms Lifeline. Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists. Kidney Int. 66(4):1622–1632, 2004.

    Google Scholar 

  17. Bradbury, B. D., et al. Conversion of vascular access type among incident hemodialysis patients: description and association with mortality. Am. J. Kidney Dis. 53(5):804–814, 2009.

    Google Scholar 

  18. Brescia, M. J., et al. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N. Engl. J. Med. 275(20):1089–1092, 1966.

    Google Scholar 

  19. Brown, E. A., and L. Johansson. Epidemiology and management of end-stage renal disease in the elderly. Nat. Rev. Nephrol. 7(10):591–598, 2011.

    Google Scholar 

  20. Canadian Society of, N., Report of the Canadian Society of nephrology vascular access working group. Semin. Dial. 25(1):22–25, 2012.

  21. Canaud, B., et al. Clinical practices and outcomes in elderly hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin. J. Am. Soc. Nephrol. 6(7):1651–1662, 2011.

    Google Scholar 

  22. Chan, M. R. Hemodialysis central venous catheter dysfunction. Semin. Dial 21(6):516–521, 2008.

    Google Scholar 

  23. Chan, R., et al. The effects of kidney-disease-related loss on long-term dialysis patients’ depression and quality of life: positive affect as a mediator. Clin. J. Am. Soc. Nephrol. 4(1):160–167, 2009.

    Google Scholar 

  24. Chaudhry, M., et al. Seeing eye to eye: the key to reducing catheter use. J. Vasc. Access 12(2):120–126, 2011.

    Google Scholar 

  25. Clinical practice guidelines for vascular access. Am. J. Kidney Dis. 48:S176–S273, 2006.

  26. Collins, A. J., et al. US renal data system 2010 annual data report. Am. J. Kidney Dis. 57(1):A8, 2011.

    Google Scholar 

  27. Collins, A. J., et al. US renal data system 2012 annual data report. Am. J. Kidney Dis. 61(1):E1–E459, 2013.

    Google Scholar 

  28. Dember, L. M., et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 299(18):2164–2171, 2008.

    Google Scholar 

  29. Desilva, R. N., et al. Fistula first is not always the best strategy for the elderly. J. Am. Soc. Nephrol. 24(8):1297–1304, 2013.

    Google Scholar 

  30. Dhingra, R. K., et al. Type of vascular access and mortality in US hemodialysis patients. Kidney Int. 60(4):1443–1451, 2001.

    Google Scholar 

  31. Dinwiddie, L. “Eligibility” is key word in Fistula First Breakthrough Initiative in determining fistula use. Nephrol. News Issues 20(9):39–40, 2006.

    Google Scholar 

  32. Dwyer, A., et al. A vascular access coordinator improves the prevalent fistula rate. Semin. Dial. 25(2):239–243, 2012.

    Google Scholar 

  33. Ethier, J., et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol. Dial Transpl. 23(10):3219–3226, 2008.

    Google Scholar 

  34. Feldman, H. I., et al. Hemodialysis vascular access morbidity in the United States. Kidney Int. 43(5):1091–1096, 1993.

    Google Scholar 

  35. Feldman, H. I., S. Kobrin, and A. Wasserstein. Hemodialysis vascular access morbidity. J. Am. Soc. Nephrol. 7(4):523–535, 1996.

    Google Scholar 

  36. Fistula First National Access Improvements Initiative. http://www.fistulafirst.org/. Assessed May 19, 2011.

  37. Fistula First Catheter Last Initiative. http://esrdncc.org/ffcl/. Accessed December 9, 2016.

  38. Gibson, K. D., et al. Assessment of a policy to reduce placement of prosthetic hemodialysis access. Kidney Int. 59(6):2335–2345, 2001.

    Google Scholar 

  39. Gomes, A., R. Schmidt, and J. Wish. Re-envisioning Fistula First in a patient-centered culture. Clin. J. Am. Soc. Nephrol. 8(10):1791–1797, 2013.

    Google Scholar 

  40. Hakim, R. M., and J. Himmelfarb. Hemodialysis access failure: a call to action-revisited. Kidney Int. 76:1040–1048, 2009.

    Google Scholar 

  41. Hemmelgarn, B. R., et al. Progression of kidney dysfunction in the community-dwelling elderly. Kidney Int. 69(12):2155–2161, 2006.

    Google Scholar 

  42. Jacob, E. T., Z. Shapira, and G. Boner. Dacron arterio-venous interposition graft: an access to circulation in patients on chronic hemodialysis. Angiology 28(1):31–35, 1977.

    Google Scholar 

  43. Johnson, J. M., D. Goldfarb, and L. D. Baker, Jr. Expanded polytetrafluoroethylene as a small artery replacement. A preliminary report. Am. J. Surg. 132(6):723–727, 1976.

    Google Scholar 

  44. Kalantar-Zadeh, K., et al. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J. Am. Soc. Nephrol. 12(12):2797–2806, 2001.

    Google Scholar 

  45. Kalloo, S., P. G. Blake, and J. Wish. A patient-centered approach to hemodialysis vascular access in the Era of Fistula first. Semin Dial 29(2):148–157, 2016.

    Google Scholar 

  46. Kinney, R. 2005 annual report: ESRD clinical performance measures project. Am. J. Kidney Dis. 48:S1–S105, 2006.

    Google Scholar 

  47. Kosa, S. D., C. Bhola, and C. E. Lok. Measuring patient satisfaction with vascular access: vascular access questionnaire development and reliability testing. J. Vasc. Access 16(3):200–205, 2015.

    Google Scholar 

  48. Kurella, M., et al. Octogenarians and nonagenarians starting dialysis in the United States. Ann. Intern. Med. 146(3):177–183, 2007.

    Google Scholar 

  49. Lacson, Jr, E., et al. Change in vascular access and hospitalization risk in long-term hemodialysis patients. Clin. J. Am. Soc. Nephrol. 5(11):1996–2003, 2010.

    Google Scholar 

  50. Lazarides, M. K., et al. A meta-analysis of dialysis access outcome in elderly patients. J. Vasc. Surg. 45(2):420–426, 2007.

    Google Scholar 

  51. Leake, A. E., et al. Arteriovenous grafts are associated with earlier catheter removal and fewer catheter days in the United States Renal Data System population. J. Vasc. Surg. 62(1):123–127, 2015.

    MathSciNet  Google Scholar 

  52. Lee, T., P. Roy-Chaudhury, and C. V. Thakar. Improving incident fistula rates: a process of care issue. Am. J. Kidney Dis. 57(6):814–817, 2011.

    Google Scholar 

  53. Lok, C. E., et al. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J. Am. Soc. Nephrol. 17(11):3204–3212, 2006.

    Google Scholar 

  54. Lok, C. E. Fistula first initiative: advantages and pitfalls. Clin. J. Am. Soc. Nephrol. 2(5):1043–1053, 2007.

    Google Scholar 

  55. Lok, C. E. Fistula first initiative: advantages and pitfalls. Clin. J. Am. Soc. Nephrol. 2(5):1043–1053, 2007.

    Google Scholar 

  56. Lynch, J. R., et al. Achieving the goal of the Fistula First breakthrough initiative for prevalent maintenance hemodialysis patients. Am. J. Kidney Dis. 57(1):78–89, 2011.

    Google Scholar 

  57. Moist, L. M., et al. Optimal hemodialysis vascular access in the elderly patient. Semin. Dial. 25(6):640–648, 2012.

    Google Scholar 

  58. Moist, L. M., and A. A. Al-Jaishi. Preparation of the dialysis access in stages 4 and 5 CKD. Adv. Chronic Kidney Dis. 23(4):270–275, 2016.

    Google Scholar 

  59. Moss, A. H., et al. Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access. Am. J. Kidney Dis. 12(6):492–498, 1988.

    Google Scholar 

  60. NKF-DOQI Clinical Practice Guidelines for Vascular Access. National kidney foundation-dialysis outcomes quality initiative. Am. J. Kidney Dis. 30(4 Suppl 3):S150–S191, 1997.

    Google Scholar 

  61. National Kidney Foundation. DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis 37(1):S137–S181, 2001.

    Google Scholar 

  62. Ohira, S., et al. 2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis. Ther. Apher. Dial. 10(5):449–462, 2006.

    Google Scholar 

  63. O’Hare, A. M., et al. When to refer patients with chronic kidney disease for vascular access surgery: should age be a consideration? Kidney Int. 71(6):555–561, 2007.

    Google Scholar 

  64. O’Hare, A. M., et al. Age affects outcomes in chronic kidney disease. J. Am. Soc. Nephrol. 18(10):2758–2765, 2007.

    Google Scholar 

  65. Polkinghorne, K. R., M. Seneviratne, and P. G. Kerr. Effect of a vascular access nurse coordinator to reduce central venous catheter use in incident hemodialysis patients: a quality improvement report. Am. J. Kidney Dis. 53(1):99–106, 2009.

    Google Scholar 

  66. Prakash, S., and A. M. O’Hare. Interaction of aging and chronic kidney disease. Semin. Nephrol. 29(5):497–503, 2009.

    Google Scholar 

  67. Quinn, R. R., et al. The vascular access questionnaire: assessing patient-reported views of vascular access. J. Vasc. Access 9(2):122–128, 2008.

    Google Scholar 

  68. Quinton, W., D. Dillard, and B. H. Scribner. Cannulation of blood vessels for prolonged hemodialysis. Trans. Am. Soc. Artif. Intern. Organs. 6:104–113, 1960.

    Google Scholar 

  69. Richardson, 2nd, A. I., et al. Should fistulas really be first in the elderly patient? J. Vasc. Access 10(3):199–202, 2009.

    Google Scholar 

  70. Robbin, M. L., et al. US vascular mapping before hemodialysis access placement. Radiology 217(1):83–88, 2000.

    MathSciNet  Google Scholar 

  71. Saran, R., et al. Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study. Ann. Surg. 247(5):885–891, 2008.

    Google Scholar 

  72. Saran, R., et al. US renal data system 2014 annual data report: epidemiology of kidney disease in the United States. Am. J. Kidney Dis. 66(1):7–8, 2015.

    Google Scholar 

  73. Schwab, S. J., et al. Prospective evaluation of a Dacron cuffed hemodialysis catheter for prolonged use. Am. J. Kidney Dis. 11(2):166–169, 1988.

    Google Scholar 

  74. Shechter, S. M., M. R. Skandari, and N. Zalunardo. Timing of arteriovenous fistula creation in patients With CKD: a decision analysis. Am. J. Kidney Dis. 63(1):95–103, 2014.

    Google Scholar 

  75. Shingarev, R., et al. Arteriovenous graft placement in predialysis patients: a potential catheter-sparing strategy. Am. J. Kidney Dis. 58(2):243–247, 2011.

    Google Scholar 

  76. Shusterman, N. H., K. Kloss, and J. L. Mullen. Successful use of double-lumen, silicone rubber catheters for permanent hemodialysis access. Kidney Int. 35(3):887–890, 1989.

    Google Scholar 

  77. Sidawy, A. N., et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J. Vasc. Surg. 48(5 Suppl):2S–25S, 2008.

    Google Scholar 

  78. Silva, Jr, M. B., et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J. Vasc. Surg. 27(2):302–307, 1998.

    Google Scholar 

  79. Spergel, L. M. Has the Fistula First Breakthrough Initiative caused an increase in catheter prevalence? Semin. Dial 21(6):550–552, 2008.

    Google Scholar 

  80. Tordoir, J., et al. EBPG on vascular access. Nephrol. Dial. Transplant. 22(2):88–117, 2007.

    Google Scholar 

  81. Vachharajani, T. J., et al. Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States. Semin. Dial. 24(5):564–569, 2011.

    Google Scholar 

  82. Vachharajani, T. J., et al. Elderly patients with CKD–dilemmas in dialysis therapy and vascular access. Nat. Rev. Nephrol. 10(2):116–122, 2014.

    Google Scholar 

  83. Vassalotti, J. A., et al. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin. Dial. 25(3):303–310, 2012.

    Google Scholar 

  84. Wish, J. B. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future. Semin. Dial. 23(6):614–618, 2010.

    Google Scholar 

  85. Xi, W., et al. Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol. Dial. Transplant. 26:3302–3308, 2011.

    Google Scholar 

  86. Yoder, L. A., et al. Patient care staffing levels and facility characteristics in U.S. hemodialysis facilities. Am. J. Kidney Dis. 62(6):1130–1140, 2013.

    Google Scholar 

  87. Yuo, T. H., et al. Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation. J. Vasc. Surg. 62(6):1590–1597, 2015.

    Google Scholar 

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Funding

Dr. Lee is supported by an American Society of Nephrology Carl W. Gottschalk Scholar Grant, University of Alabama at Birmingham Nephrology Research Center Anderson Innovation Award, University of Alabama at Birmingham Center for Clinical and Translational Science Multidisciplinary Pilot Award (1UL1TR001417-01), grant 1R43DK109789-01 from National Institutes of Diabetes, Digestive and Kidney Diseases (NIDDK) and grant 1I01BX003387-01A1 from a Veterans Affairs Merit Award.

Conflict of interest

Dr. Lee is a consultant for Proteon Therapeutics and Merck. Dr. Lee serves as a counselor for the American Society of Diagnostic and Interventional Nephrology and serves as a member of the National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) Guideline workgroup.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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  1. Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-0007, USA

    Timmy Lee

  2. Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA

    Timmy Lee

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Associate Editors James E. Moore, Jr., Michael Walsh, and Ajit P. Yoganathan oversaw the review of this article.

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Lee, T. Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care. Cardiovasc Eng Tech 8, 244–254 (2017). https://doi.org/10.1007/s13239-017-0319-9

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