If you have decided on Hemodialysis as your choice for Renal Replacement Therapy, you require the placement of an AVF-arterio-venous fistula, hopefully prior to the initiation of dialysis, as it needs about 2 months to fully mature. This article is reprinted from the Southeastern Kidney Council, and drives home the point on why dialysis cannot be done longterm with a catheter.
Vascular access is the “lifeline” for hemodialysis patients. Your access allows blood to be pumped from your body, cleaned and returned to your body. The three most common types of vascular access are catheters, grafts and fistulas. Experts agree that the best access for hemodialysis is an arteriovenous (AV) fistula. An AV fistula is created when an artery and a vein are surgically joined together.
The Centers for Medicare & Medicaid Services (CMS) Administrator Mark B. McClellan MD, PhD said, “Fistulas are the gold standard for establishing access to a patient’s circulatory system in order to provide life-sustaining dialysis”. He also said, “They last longer, need less rework, and are associated with lower infection rates, hospitalization and death for Medicare beneficiaries than other types of access.” For these reasons, in July 2003, work began on a special project called the National Vascular Access Improvement Initiative, also known as Fistula First.
“Fistula First” is a National Initiative to increase the use of AV fistulas in hemodialysis patients. “This initiative aims to improve the quality of care and quality of life for Americans living with kidney failure” said Health and Human Services Tommy G. Thompson.
The “Fistula First” initiative goal is to have fistulas placed in at least half of new dialysis patients and maintaining fistulas in 66 percent of eligible patients. CMS has partnered with the 18 ESRD Networks, dialysis providers, primary care physicians, nephrologists, vascular access surgeons, interventional radiologists, state survey agencies, professional societies and pa- tient advocacy groups to help reach this goal. Currently only 40 percent of Medicare patients dialyze with a fistula. As of October 2005, 37.5% prevalent hemodialysis patients in Network 6 (North Carolina, South Carolina and Georgia) were dialyzing via a fistula.
This special edition of the Renal Health News will focus on the advantages of a fistula; from its importance to how to care for and keep your fistula working.
