NDT Advance Access originally published online on July 13, 2004
Nephrology Dialysis Transplantation 2004 19(9):2334-2340; doi:10.1093/ndt/gfh363
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved
Original Article
Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS
1 Division of Nephrology, Department of Internal Medicine, 2 Kidney Epidemiology and Cost Center, University of Michigan, 3 University Renal Research and Education Association, 10 Division of Nephrology, Department of Veterans Affairs Medical Center, Ann Arbor, Michigan, 6 Nephrology Department, Lapeyronie University Hospital, Montpellier, France, 7 Government Relations, Amgen Inc., Washington, DC, USA, 4 Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, 5 Center of Blood Purification Therapy, Wakayama Medical University, Wakayama, 9 Institute of Medical Science, Tokai University School of Medicine, Kanagawa, Japan and 8 Nephrology Service, Hospital General Vall d’Hebron, Barcelona, Spain
Correspondence and offprint reqiuests to: Rajiv Saran, MD, MS, Kidney Epidemiology and Cost Center, University of Michigan 315 W. Huron, Suite 240, Ann Arbor, MI 48103, USA. Email: rsaran{at}umich.edu
Background. Optimal waiting time before first use of vascular access is not known.
Methods. Two practices—first cannulation time for fistulae and grafts, and blood flow rate—were examined as potential predictors of vascular access failure in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Access failure (defined as time to first failure or first salvage intervention) was modelled using Cox regression.
Results. Among 309 haemodialysis facilities, 2730 grafts and 2154 fistulae were studied. For grafts, first cannulation typically occurred within 2–4 weeks at 62% of US, 61% of European and 42% of Japanese facilities. For fistulae, first cannulation occurred <2 months after placement in 36% of US, 79% of European and 98% of Japanese facilities. Overall, the relative risk (RR) of graft failure in Europe was lower compared with the USA (RR = 0.69, P = 0.04). The RR of graft failure (reference group = first cannulation at 2–3 weeks) was 0.84 with first cannulation at <2 weeks (P = 0.11), 0.94 with first cannulation at 3–4 weeks (P = 0.48) and 0.93 with first cannulation at >4 weeks (P = 0.48). The RR of fistula failure was 0.72 with first cannulation at <4 weeks (P = 0.08), 0.91 at 2–3 months (P = 0.43) and 0.87 at >3 months (P = 0.31) (reference group = first cannulation at 1–2 months). Facility median blood flow rate was not a significant predictor of access failure.
Conclusions. Earlier cannulation of a newly placed vascular access at the haemodialysis facility level was not associated with increased risk of vascular access failure. Potential for confounding due to selection bias cannot be excluded, implying the importance of clinical judgement in determining time to first use of vascular access.
Keywords: access monitoring; blood flow rate; cannulation; haemodialysis; practice pattern; vascular access
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