EFFECTIVENESS OF MULTIMODAL INTERVENTIONS IN IMPROVING ARTERIOVENOUS FISTULA (AVF) USE OF NEW PLANNED HAEMODIALYSIS PATIENTS – A SINGLE CENTRE STUDY

PG TAN1, D LANGSFORD1, T PIANTA1, D BARIT1
1Northern Health, Epping, Australia

Aim: To evaluate if multidisciplinary interventions increase AVF use at time of planned haemodialysis initiation.
Background: The Victorian Key Performance Indicator (KPI) for commencement of planned haemodialysis with an AVF is 70%. In 2015, a multidisciplinary approach to improve fistula use at haemodialysis initiation was commenced: one-on-one chronic kidney disease education, use of vascular led arteriovenous ultrasound mapping and a combined nephrologist-vascular surgical AVF planning and triage clinic.
Methods: Patients commencing planned haemodialysis, AVF creation and prevalent use of permacath between 1/1/15 and 31/12/17 were retrospectively analysed. Quarterly KPI data from June 2015 to December 2017 was compared to state average. Patients that underwent pre-dialysis AVF creation were retrospectively stratified into low- or high-risk of dialysis need based on calculated 8-Variable Kidney Failure Risk Equation (KFRE) from demographic and renal specific data at time of vascular referral.
Results: Across the study period, 68 patients commenced haemodialysis whilst 85 underwent AVF creation. AVF use upon haemodialysis commencement consistently improved from 57% to 91%, compared to the statewide average of 56%-66%. Prevalent permacath rate fell from 18.3% to 10%.  Pre-dialysis AVF creation had increased from 74% to 85%. Amongst those who started dialysis with catheters, 50% had poor engagement with the Unit and 22% had late decision change regarding preferred dialysis modality. High-risk patients with KFRE score ≥20% had shorter waiting time for AVF creation (median 45 days(IQR95.75-294.25) vs 142days(IQR30-115), p-value <0.001) but no difference in time from access creation to dialysis commencement. There were no significant changes in patient characteristics over this period.
Conclusions: Multimodal interventions including joint assessment by nephrologists and vascular surgeons may improve triaging of patients and AVF use at haemodialysis commencement.


Biography:
Pek Ghe Tan is one of the Renal advanced trainee in Victoria. She is currently in her final year of training at the Northern Hospital.

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