Epidemiology of Vascular Access for Hemodialysis and Related Practice Patterns

Abstract

The vital importance of vascular access (VA) for optimal delivery of hemodialysis (HD) is well recognized. Timely creation and meticulous maintenance of these 'lifelines' are crucial for the care of HD patients. Clinical practice guidelines [1] have therefore made VA a priority area. According to the 2002 USRDS report [2], the number of HD VA procedures increased by almost 4 times between 1991 and 2000, while costs for these procedures grew from USD 104 million to almost USD 200 million. Over this time, delivery of VA services has moved steadily from the inpatient to the outpatient arena. As a result, the physician and institutional payments have decreased for all types of VA services in the United States. However, VA procedures and complications have been reported previously to account for over 20% of hospitalizations of dialysis patients in the United States and cost about USD 1 billion annually, and therefore remain the single greatest categorical expense for dialysis patient care [3,4].This chapter aims to provide a critical overview of the epidemiology of VA utilization as well as an appraisal of recent literature with regard to patterns of practice that have been observed to affect VA outcomes. VA Practices around the WorldThe Dialysis Outcomes and Practice Patterns Study (DOPPS) [5] is undoubtedly a rich international resource of epidemiological data pertaining to

Treatment of dialysis access puncture wound bleeding with chitosan dressings

“…2 The cost of access procedures and complications has been estimated at $1 billion annually, the single greatest categorical expense for dialysis patient care. 2 Although repeated access to these sites with catheters is considered the most common traumatic insult, occlusive pressure dressings and compression devices also contribute.…”

“…2 The cost of access procedures and complications has been estimated at $1 billion annually, the single greatest categorical expense for dialysis patient care. 2 Although repeated access to these sites with catheters is considered the most common traumatic insult, occlusive pressure dressings and compression devices also contribute. 3 Improved hemostasis dressings with active clotting surfaces and components have been recently reported in trauma and other literature to accelerate hemostasis in moderate to severe bleeding.…”

Characteristics of the clinical practice patterns of hemodialysis in Japan in consideration of DOPPS and the NKF/DOQI guidelines

“…Vascular access provides a lifeline for HD patients, and the DOPPS has shown many varieties in the treatment practices for vascular access [4][5][6]8]. The NKF/K-DOQI guidelines for vascular access recommended native arterio-venous (AV) fistula over AV grafts or catheters for permanent vascular access [35].…”

Tracking Arteriovenous Fistula Maturation: A Novel Approach

“…HD patients with a newly created AVF may continue to use CVCs for prolonged periods because of inappropriate maturation or failure to maintain patency. The extended use of a CVC is associated with adverse outcomes [12,[18][19][20].…”