Gill S, et al. - This study assessed the probability of using a fistula catheter-free, and rates of access-related procedures in incident patients receiving hemodialysis, in relation to the introduction of a multidisciplinary access team, including nurses, surgeons, and radiologists. As a consequence of the introduction of a multidisciplinary access team, higher rates of fistula-related procedures were reported, in addition to no increase in the probability of catheter-free fistula use.

Methods

• Vascular access outcomes were assessed in the first year of hemodialysis treatment before (2004–2005, preteam period) and after the implementation of an access team (2006–2008, early-team period; 2009–2011, late-team period) in the Calgary Health Region, Canada.
• The probability of fistula creation and the probability of catheter-free fistula use were studied via logistic regression, and access-related procedure rates via negative binomial regression.

Results

• 609 adults (mean age, 65 [±15] years; 61% men; 54% with diabetes) were included.
• Data reported that by the end of the first year of hemodialysis, 102 participants received a fistula in the preteam period (70%), 196 (78%) in the early-team period (odds ratios versus preteam, 1.47; 95% confidence interval, 0.92 to 2.35), and 139 (66%) in the late-team period (0.85; 0.54 to 1.35).
• The probability of catheter-free use of the fistula remained unaffected by the implementation of access team (odds ratio, 0.87; 95% confidence interval, 0.52 to 1.43, for the early; and 0.89; 0.52 to 1.53, for the late team versus preteam period).
• During the first year of hemodialysis, participants underwent an average of 4–5 total access-related procedures, with higher rates in women and in people with comorbidities.
• Findings demonstrated that catheter-related procedure rates were similar before and after team implementation; relative to the preteam period, fistula-related procedure rates were 40% (20%–60%) and 30% (10%–50%) higher in the early-team and late-team periods, respectively.