Timing of nephrologist referral and arteriovenous access use: The CHOICE Study

摘要: c Recent clinical practice guidelines recommend the creation of an arteriovenous (AV) vascular access (ie, native fistula or synthetic graft) before start chronic hemodialysis therapy to prevent need for complicationprone dialysis catheters. We report on association referral a nephrologist with duration dialysis-catheter use and type used in first 6 months therapy. The study population is representative cohort 356 patients questionnaire, laboratory, medical record data collected as part Choices Healthy Outcomes Caring End-Stage Renal Disease Center Study. Patients who reported being seen by at least 1 month starting (75%) were more likely than those referred later AV initiation (39% versus 10%; P < 0.001) after (74% 56%; 0.01). within initiating catheter median 202 days compared 64, 67, 19 4, 4 12, greater 12 therapy, respectively (P trend 0.001). fistula, rather graft, their (45% 31%;P These associations remained adjustment age, sex, race, marital status, education, insurance coverage, comorbid disease albumin level, body mass index, underlying renal diagnosis. show that late substantially increases likelihood associated prolonged use. Regardless time referral, only minority treatment, 25% had not initiation. Thus, further efforts improve both patterns preparation are needed. © 2001 National Kidney Foundation, Inc.