NDT Advance Access originally published online on November 25, 2005
Nephrology Dialysis Transplantation 2006 21(3):721-728; doi:10.1093/ndt/gfi281
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II)
1 Division of Nephrology, Humber River Regional Hospital and University of Toronto, Weston, ON, Canada 2 Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada, 3 University Renal Research and Education Association, Ann Arbor, MI, 4 Division of Nephrology, Kidney Epidemiology and Cost Center, Ann Arbor, MI and 5 Department of Veterans Affairs Medical Center and Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
Correspondence and offprint requests to: D. C. Mendelssohn, Humber River Regional Hospital, 200 Church St. Room 2024, Weston, Ontario M9N 1N8, Canada. Email: dmendelssohn{at}hrrh.on.ca
Background. The optimal vascular access for chronic maintenance haemodialysis (HD) is the native arteriovenous fistula (AVF). Vascular access practice patterns are reported for a Canadian cohort of patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS II).
Methods. DOPPS II is a prospective, observational study in 12 countries, including Canada. A representative random sample of 20 Canadian HD facilities and patients within those units were studied during 2002–2004. Canadian results were compared with those found in Europe and the USA.
Results. AVF use in Canadian prevalent (53%) and incident (26%) patients was lower than Canadian guidelines recommend (60%), and lower than in Europe [prevalent (74%), incident (50%)]. Despite 85% of Canadian HD patients having seen a nephrologist for >1 month prior to starting dialysis, central venous catheter use in Canada (33% in prevalent patients, 70% in incident patients) was much higher than in Europe (prevalent 18%, incident 46%) and slightly higher than in the USA (prevalent 25%, incident 66%). This pattern is contrary to the preferences of Canadian medical directors and vascular access surgeons. The typical time from referral until permanent vascular access creation is substantially longer in Canada (61.7 days) than in Europe (29.4 days) or the USA (16 days). This longer delay time and higher catheter use in Canada may be a consequence of the significantly lower number of access surgeons per 100 HD patients in Canada (2.9) compared with the USA (8.1) and Europe (4.6). Furthermore, the median hours per week devoted to vascular access-related surgery per 100 patients is substantially lower in Canada (0.027 h) compared with the USA (0.082 h) and Europe (0.059 h).
Conclusion. These findings suggest that Canadian chronic HD patients often rely on central venous catheters for vascular access, despite their known association with numerous detrimental outcomes in HD. Nephrologists, vascular access surgeons, interventional radiologists, other physicians and health care funding bodies must be more broadly educated about the priority of AVF creation as the preferred vascular access for chronic HD patients. They must work together to secure both the human and financial resources and other health care system enhancements to increase AVF creation rates in a timely manner.
Keywords: arteriovenous fistula; arteriovenous grafts; central venous catheters; DOPPS; haemodialysis; vascular access
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