Experts are attempting to increase the use of AVFs through initiatives such as the Fistula First Breakthrough Coalition, whereby the Centers for Medicare & Medicaid Services, End Stage Renal Disease Networks, and the entire kidney community are working together to ensure that every suitable patient will receive the most optimal form of vascular access. Dr. Hurst's findings show that despite these efforts, AVF use is still highly dependent upon a patient's type of health insurance prior to the initiation of dialysis.
"Further study of these federal systems may identify practices that could improve processes of care across healthcare systems to increase the number of patients who initiate hemodialysis with an AVF," the authors wrote. They added that while AVF use is more frequent in DVA/DoD patients, the proportion of these patients who initiate hemodialysis with an AVF is still far too low.
Study co-authors include Kevin Abbott, MD (Walter Reed Army Medical Center and F. Edward Hebert School of Medicine); Dominic Raj, MD (George Washington University); Mahesh Krishnan, MD (Davita Clinical Research); Carlos Palant, MD (Washington DC VA Medical Center and George Washington University School of Medicine); Lawrence Agodoa, MD (National Institutes of Health); and Rahul Jindal, D, PhD (George Washington University, Walter Reed Army Medical Center, and Brookdale University Medical Center).
In an accompanying editorial, Steve Schwab, MD and Kennard Brown, PhD (University of Tennessee Health Science Center) expressed dismay that AVF placement before dialysis, which requires treatment by both a nephrologist and a vascular surgeon, is not covered by Medicare, which supports most coverage for dialysis. "We now
|Contact: Shari Leventhal|
American Society of Nephrology