Background. A well-functioning vascular access (VA) is essential to efficient dialysis therapy. Guidelines have been implemented improving care, yet access use varies widely across countries and VA complications remain a problem. This study took advantage of the unique opportunity to utilize data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to examine international trends in VA use and trends in patient characteristics and practices associated with VA use from 1996 to 2007. DOPPS is a prospective, observational study of haemodialysis (HD) practices and patient outcomes at >300 HD units from 12 countries and has collected data thus far from >35000 randomly selected patients. Methods. VA data were collected for each patient at study entry (19962007). Practice pattern data from the facility medical director, nurse manager and VA surgeon were also analysed. Results. Since 2005, a native arteriovenous fistula (AVF) was used by 6791 of prevalent patients in Japan, Italy, Germany, France, Spain, the UK, Australia and New Zealand, and 5059 in Belgium, Sweden and Canada. From 1996 to 2007, AVF use rose from 24 to 47 in the USA but declined in Italy, Germany and Spain. Moreover, graft use fell by 50 in the USA from 58 use in 1996 to 28 by 2007. Across three phases of data collection, patients consistently were less likely to use an AVF versus other VA types if female, of older age, having greater body mass index, diabetes, peripheral vascular disease or recurrent cellulitisgangrene. In addition, countries with a greater prevalence of diabetes in HD patients had a significantly lower percentage of patients using an AVF. Despite poorer outcomes for central vein catheters, catheter use rose 1.5- to 3-fold among prevalent patients in many countries from 1996 to 2007, even among non-diabetic patients 1870 years old. Furthermore, 5873 of patients new to end-stage renal disease (ESRD) used a catheter for the initiation of HD in five countries despite 6079 of patients having been seen by a nephrologist >4 months prior to ESRD. Patients were significantly (P < 0.05) less likely to start dialysis with a permanent VA if treated in a faciity that (1) had a longer time from referral to access surgery evaluation or from evaluation to access creation and (2) had longer time from access creation until first AVF cannulation. The median time from referral until access creation varied from 56 days in Italy, Japan and Germany to 4043 days in the UK and Canada. Compared to patients using an AVF, patients with a catheter displayed significantly lower mean KtV levels. Conclusions. Most countries meet the contemporary National Kidney Foundation's Kidney Disease Outcomes Quality Initiative goal for AVF use; however, there is still a wide variation in VA preference. Delays between the creation and cannulation must be improved to enhance the chances of a future permanent VA. Native arteriovenous fistula is the VA of choice ensuring dialysis adequacy and better patient outcomes. Graft is, however, a better alternative than catheter for patients where the creation of an attempted AVF failed or could not be created for different reasons.

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   |wiki=    Wicri/Belgique
   |area=    OpenAccessBelV2
   |flux=    Istex
   |étape=   Checkpoint
   |type=    RBID
   |clé=     ISTEX:4CC204E255765FE8D3C81A4633C1147B81A89B31
   |texte=   Vascular access use and outcomes: an international perspective fromthe dialysis outcomes and practice patterns study
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