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.
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.