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Kaiser Permanente Research Shows That Use of More Fistulas Markedly Improves Kidney Dialysis Treatment

Posted on: Friday, 6 January 2006, 12:00 CST

Kaiser Permanente Southern California investigators have shown that dialysis patients treated using surgically created arteriovenous fistulas, a joining of a vein to an artery, enjoy markedly improved outcomes. Results indicate a progressive increase in the fistula rate from 30 percent in 1997 to 62 percent in 2003. At the same time, the need for re-intervention on the access was cut almost in half.

Kaiser Permanente Southern California physicians have demonstrated that a multidisciplinary continuous quality improvement (CQI) program has improved care for dialysis patients whose survival depends upon repeated access to a patient's circulatory system. Continuous quality improvement refers to applying the scientific method to any process, in this case, the practice of medicine.

The study is published in the January, 2006, issue of Annals of Vascular Surgery.

"About 65 percent of people in the U.S. who are on hemodialysis are treated using a catheter or graft. These devices are more prone to clot or become infected than fistulas," said Sidney Glazer, MD, Department of Surgery, Southern California Kaiser Permanente, and the first author of the study. "What we have confirmed is by using the patient's own blood vessels to create a hemodialysis fistula, we can provide a much more reliable access.

"When this was studied about a decade ago, it was found that about 80 percent of patients in Europe were treated using a fistula but only 20 percent of U.S. patients were treated with fistulas," said Glazer. "Many people in the U.S., led by the National Kidney Foundation and the Fistula First project, have been working to improve this situation. Today almost 40 percent of U.S. patients have a fistula, a big improvement but still far behind what could be done.

"When a vein is connected to an artery, blood flow in both increases 10 to 20 times. Both vessels dilate, but especially the vein," said Glazer. "This is important because a dialysis machine needs to withdraw four to five hundred milliliters of blood per minute in order to work satisfactorily. After cleaning the blood, the machine returns it back to the patient," said Glazer.

In 1996, a multidisciplinary continuous quality improvement committee was formed as part of Kaiser Permanente Southern California's participation in the Medicare End Stage Renal Disease Managed Care Demonstration Project. From Jan. 1, 1997, to Dec. 31, 2003, data was gathered on all patients beginning hemodialysis and/or having any access interventions.

In addition to Dr. Glazer, the study's other authors are: Jean Diesto, RN, BSN; Peter Crooks, MD; Hock Yeoh, MD; Noel Pascual; and David Selevan, all of the Department of Nephrology, Southern California Permanente Medical Group; Stephen Derose, MD, MS, Department of Research, Southern California Permanente Medical Group; and Michael Farooq, MD, Department of Surgery, Southern California Permanente Medical Group.

Kaiser Permanente (www.kaiserpermanente.org) is America's leading integrated health plan. Founded in 1945, it is a nonprofit, group practice prepayment program with Southern California headquarters in Pasadena. Kaiser Permanente serves the health care needs of 3.1 million members in Southern California. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc.; Kaiser Foundation Hospitals and their subsidiaries; and the for-profit Southern California Permanente Medical Group. Kaiser Permanente's Southern California Region includes more than 47,530 technical, administrative and clerical employees and caregivers, and more than 5,200 physicians representing all specialties.

Source: Business Wire

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