T YOUNG1,2,4, L PHIPPS3,4
1Bathurst Base Hospital, Bathurst, Australia, 2Lithgow Hospital, Lithgow , Australia, 3Orange Health Service, Orange, Australia, 4University of Sydney, ,
Aim: To review type of initial access in patients commencing haemodialysis (HD) in a regional setting in relation to their geographic location.
Background: An arteriovenous fistula (AVF) is the gold standard for initial access in HD(1). The challenges in our regional setting include access to specialist vascular surgeon input and distance to both our facility and tertiary facilities.
In response to an audit revealing high rates of CVC use in our facility we developed a multidisciplinary strategy (involving recruitment of visiting vascular surgeon, patient education and dedicated vascular ultrasonography) to ensure timely AVF formation. We then audited this strategy.
Results: 105 cases were analysed.There was a statistically significant increase in patients commencing HD with an AVF after implementation of our strategy.
The data also revealed patients commencing with a CVC had a tendency to live further from our centre than patients with an AVF (76.0km vs 41.52km), and had a greater number of hospitalisations.Patients with a CVC had higher mortality rates at the end of the first year of HD compared to patients with an AVF(17.8%vs 10.8%).
Conclusion: We demonstrated greater numbers of patients commencing HD with an AVF following implementation of a multidisciplinary approach.
CVC use was more common in patients with a greater distance to travel to access our service, indicating that travel time may be a barrier to optimal care. CVC use was associated with higher number of hospitalisations and mortality in our cohort. Future service development should focus on enabling equitable service provision for all patients, regardless of their geographic location.1)KHA-CARI Guidelines: Polkinghorne et al Nephrology 2013;18(11):701-5.
Dr Tamara Young is an Endocrinologist and General Physician. She has a strong interest in Nephology, and spent one year working as a renal registrar in Orange in 2017; whilst completing advanced training in general and acute care medicine. She works as an endocrinologist at Bathurst and Lithgow hospitals and does outreach clinics to Bourke and Brewarrina. In 2018 she also commenced research at The George Institute for Global Health