NDT Advance Access originally published online on April 23, 2007
Nephrology Dialysis Transplantation 2007 22(9):2595-2600; doi:10.1093/ndt/gfm221
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Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative
1Department of Nephrology, 2Department of Vascular Surgery and 3Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Correspondence and offprint requests to: Peter J. Blankestijn, MD, PhD, Department of Nephrology, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Email: P.J.Blankestijn{at}umcutrecht.nl
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Abstract |
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Background. In the Netherlands, arteriovenous fistulas (AVFs) are used in 60–65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs.
Methods. Physicians and dialysis staff in 11 participating centres (N = 1092 vascular accesses) were strongly and repeatedly advised to adhere to current guidelines with extra attention for pre-operative duplex examination and salvaging of failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses using an internet-linked database. In 22 other centres (N = 1566 accesses), the CIMINO programme was not offered and they were considered the control group.
Results. On 1 January 2006, average follow-up time of the CIMINO group and the control group were 13.3 months and 34.1 months, respectively. A total of 598 new vascular accesses (77% AVFs) were created in the CIMINO group. Prevalent AVF use increased from 58.5% (range: 31–79%) to 62.7% (range: 45–83%) in the CIMINO group and from 65.5% (range: 31–91%) to 67.3% (range: 42–91%) in the control group. The increase in AVF use per year was significantly quicker than in the control group (P < 0.05). Use of untunnelled catheters decreased whereas that of tunnelled catheters increased.
Conclusions. This initiative shows that a multicentre guidelines implementation programme results in an accelerated increase of AVF use in comparison with a time control group. These data suggest that the choice of access placement depends predominantly on centre-specific factors.
Keywords: arteriovenous fistula; haemodialysis; practice pattern; quality improvement; vascular access
Members listed in the appendix.
Received for publication: 15.12.06
Accepted in revised form: 21. 3.07
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  H. J.T. Huijbregts, M. L. Bots, C. H.A. Wittens, Y. C. Schrama, F. L. Moll, P. J. Blankestijn, and on behalf of the CIMINO study group Hemodialysis Arteriovenous Fistula Patency Revisited: Results of a Prospective, Multicenter Initiative Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 714 - 719. [Abstract] [Full Text] [PDF]
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