Fistula Use Increases Among Americans With Kidney Failure

Initiative Educates Providers, Patients About Benefits of Fistulas

The number of people with kidney failure who use fistulas for dialysis has climbed to 42 percent from 30 percent in a year and a half thanks to an initiative launched by the Centers for Medicare and Medicaid Services (CMS) in partnership with other Government, professional, and advocacy groups.

The goal of the Fistula First Breakthrough Initiative is to realize one of the Health and Human Services Department’s Healthy People 2010 objectives: to have fistulas placed in at least half of all new hemodialysis patients and to have a minimum of 66 percent of all existing patients who continue dialysis use a fistula.

“In the rest of the developed world, 80 to 90 percent of all dialysis patients use fistulas,” said Paul Eggers, Ph.D., program director for Kidney and Urology Epidemiology at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Fistulas are associated with fewer complications requiring hospitalization, according to the CMS. Catheters have the highest infection rate of any access procedure and grafts have the second highest; fistulas have the lowest infection rate and last the longest.

“And they cost less,” said Eggers. That’s because fistulas are cheaper to place and maintain than catheters and grafts. “Increasing the number of Americans who use fistulas works to the financial benefit of everyone in the long run.”

Mounting Costs

Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions, contributing to about $1.5 billion in Medicare costs annually, according to the CMS. More than 300,000 Medicare beneficiaries currently receive dialysis—a number that is expected to double by 2010.

The NIDDK and organizations representing dialysis providers, primary care physicians, nephrologists, vascular access surgeons, interventional radiologists/nephrologists, professional societies, quality improvement organizations, networks, and patient advocacy groups are part of the Initiative’s national coalition working to educate patients and health care providers about using fistulas.

“Leadership from the vascular surgeon and nephrology community is critical,” Eggers said. “We also have to convince patients that a fistula is the preferred and default access. This effort requires educational materials, best practices for doctors and nurses, and other efforts. It’s not an easy sort of fix.”

In addition to training packages, position papers, and other educational materials, the Initiative has established a website, www.fistulafirst.org. Visit
http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/index.htm to read or download a fact sheet about vascular access for hemodialysis.

NIH Publication No. 07–4531
November 2006