SOME TEACHING POINTS FROM ASN 2011 Pre course on Dialysis Care
We all know that mortality is very high for incident hemodialysis and could reach as high as 50%.
Hakim et all showed in a retrospective study in looking at Fersenius data. They looked 10 years back and found out that those with the highest mortality had catheters. One conclusion could be that these deaths could be infectious complications. It behooves us therefore to prevent these kind of deaths.
Unfortunately people had these catheters and died despite the fact that thery were followed by nephrologists for more than six months.
Bradbury et al, AJKD, 2009 showed that mortality decreased by 36% and 29% when catheter was changed to AVF, and AVG respectively; and mortality increased by 80% when permanent access was changed to a catheter.
What are some reasons to this suboptimal care:
Late referal to nephrology, priamary avf failure, patient-induced delays and in-decisions, etc. (NDT)
Patients were reluctant bc of fear of needels and fear of surgery and prior failures of fistulas.
Our job as nephrologists is to prevent these deaths and spend the time and energy to convince patients get AVF or AVG.
Hofstra NSLIJ Nephrology
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