Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines
Section snippets
Creation and use of permanent vascular access
A significant proportion of patients with end-stage renal disease (ESRD) present for the first time to a nephrologist immediately before requiring dialysis. Moderate differences exist between countries in the percentage of patients presenting late.2 The chances of dialysis commencing via permanent rather than temporary access and via AV fistula rather than graft are significantly higher in patients who receive nephrologic care for more than 30 days before starting dialysis (adjusted odds ratio
Hemodialysis catheter use
Although the use of catheters is discouraged, it is recognized that hemodialysis catheters are unavoidable in some patients. K/DOQI Vascular Access Guideline 51 recommends that, when required, dialysis catheters be inserted in the right internal jugular vein, not in the subclavian vein, because of the risk of subclavian vein stenosis. Performance against this standard for tunneled and untunneled catheters is superior in Europe to the United States, although practice improved in the United
Outcomes associated with the use of hemodialysis catheters
The DOPPS has quantified a number of adverse outcomes that are associated with the use of hemodialysis catheters. After adjusting for patient demographic factors and comorbidities, a significant association has been shown between an increasing percentage of patients within a dialysis facility receiving hemodialysis via a catheter and lower average hemoglobin concentration and higher rates of hospitalization and mortality within that facility.8, 9 At a patient level, the risk of vascular access
Is performance improving toward K/DOQI standards?
Data have been collected for the DOPPS before and since the publication in 1997 and 2000 of the NKF-K/DOQI Clinical Practice Guidelines for Vascular Access. This allows an assessment of the possible impact of these guidelines on hemodialysis practices around the world.
Within the United States, opinion among hemodialysis facility nurse managers has shown a shift from 40% preferring grafts in 1996 to 19995 to only 7% in 2003 (unpublished observations). Correspondingly, the percentage of prevalent
Conclusions
Vascular access provides a lifeline for the hemodialysis patient, and the DOPPS has provided valuable data on this vital aspect of hemodialysis practice. By gathering data from around the world, the DOPPS has shown that performance in some countries falls short of the achieved practice in others. It has also identified areas in which K/DOQI guidelines for vascular access may be refined and performance targets raised. The DOPPS has shown that treatment practices, associated with the opinions and
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Vascular access use in Europe and the United StatesResults from the DOPPS
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Creation, cannulation and survival of arteriovenous fistulaeData from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
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Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
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Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
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Tunneled catheters in hemodialysis: Indications and complications
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2022, Artificial Intelligence in MedicinePredictors of Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula in a Cohort of Asian Patients
2020, Annals of Vascular SurgeryOutcomes of initial hemodialysis vascular access in patients initiating dialysis with a tunneled catheter
2019, Journal of Vascular SurgeryCitation Excerpt :These analyses demonstrated that consistently across the outcomes of time to THC removal, likelihood of repeat vascular access and time to repeat vascular access, AVG results in superior outcomes compared with AVF. These results can all likely be attributed to the high AVF maturation failure rate that has been repeatedly reported in the literature.15-17 AVG do not require a maturation period and, in the case of early cannulation grafts, can be punctured as early as 24-48 hours after creation, allowing for earlier THC removal.18,19
Vessel diameter and close surveillance helps predict early patency in native arteriovenous fistulas
2023, Journal of Vascular Access
The Dialysis Outcomes and Practice Patterns Study is supported by research grants from Amgen and Kirin without restrictions on publications. The NKF gratefully acknowledges the support of Amgen, founding and principal sponsor of K/DOQI. The publication of this supplement was supported by the DOPPS.