Managing the lifeline: Preemptive access management for better outcomes for hemodialysis patients and programs

Problems with vascular access for hemodialysis patients contribute substant ially to the morbidity, mortality, and high costs associated with renal rep lacement therapy. Data from the Network 9/10 Regional Hemodialysis Vascular Access Quality Improvement Project show evidence of incremental improvemen ts, with more native vein fistulae and fewer grafts. However, increased num bers of catheters were observed, and still fully 32% of the catheters in pl ace were associated with no internal access created after more than 90 days on dialysis. This article reviews recent contributions to understanding pa tterns of access-related care, pathophysiology of vascular access complicat ions, and new approaches to achieving the preferred native vein arterioveno us fistulae. A financial analysis shows that dialysis units that employ ded icated access management personnel can expect bottom-line benefits that wil l easily cover the added expense. These benefits will be in addition to imp rovements in morbidity and mortality for patients. (C) 2000 by the National Kidney Foundation, Inc.