Aim: To review outcomes following implementation of a quality improvement project regarding initial vascular access in patients with and without diabetes mellitus commencing haemodialysis
Background: An arteriovenous fistula (AVF) is the gold standard for initial access in patients new to haemodialysis (1). The challenges in our regional setting relate to access to specialist vascular surgeon input and distance to both our facility and tertiary facilities.
Patients with diabetes mellitus have poorer fistula adequacy and higher rates of arteriovenous grafts (AVG) (1). Higher mortality rates have been reported in patients with diabetes mellitus utilising a central venous catheter (CVC). (2)
Method: An initial audit of access in patients commencing dialysis demonstrated high rates of CVC use, in 12/15 patients in the preceding year.
A multifaceted, pre-emptive approach was developed utilising a vascular ultrasonographer, patient education regarding vessel preservation, and recruitment of a visiting vascular surgeon.
Results:
105 cases were analysed including cases 2 years prior to our intervention. 48/105 patients had diabetes mellitus. There was no statistically significant difference across years in the prevalence of diabetes mellitus.
After the intervention there was a statistically significant increase in patients commencing dialysis with an AVF. There was no statistically significant difference in initial access mode between patients with or without diabetes.
Conclusion: The intervention resulted in improved rates of gold standard access for initial dialysis. This was also evident in patients with diabetes mellitus. Further analysis is required to review clinical characteristics of these patients, long term outcomes, and review any impact on cost benefit to our organisation.