Impact of Single-Needle Therapy in New Chronic Hemodialysis Starts for Individuals with Arteriovenous Fistulae (Report‪)‬

Introduction Vascular access is referred to as the "lifeline" for individuals receiving hemodialysis. Clinical practice guidelines in both the U.S. and Canada recommend the native arteriovenous fistula (AVF) as the preferred access for patients requiring chronic hemodialysis (HD) (Jindal et al., 2006; National Kidney Foundation (NKF), 2006). Use of the AVF as initial access for long-term HD therapy is associated with better survival as compared to individuals using central venous catheters (CVCs) at HD initiation (Astor et al., 2005; Polkinghorne, McDonald, Atkins, & Kerr, 2004; Xue, Dahl, Ebben, & Collins, 2003). There is a higher relative risk of bacteremia with CVC catheter use than with the AVF (Hoen, Paul-Dauphin, Hestin, & Kessler, 1998). There is also some suggestion that initiation of HD with an AVF and its continued use early in end stage renal disease (ESRD) may be associated with the perception of improved health status and quality of life as compared to those using CVCs at HD initiation (Wasse, Kutner, Zhang, & Huang, 2007). Despite the existence of guidelines and the evidence to date, AVF use in Canada remains lower than the Canadian Society of Nephrology's Clinical Practice Guidelines for Vascular Access recommend (Jindal et al., 2006; Mendelssohn, 2006). DOPPS II data reported AVF use in Canada between 2002 and 2004 was 53% in prevalent patients and only 26% in incident patients. Furthermore, a recently published review of data from the Canadian Organ Replacement Registry (CORR) from 2001 to 2004 demonstrated an increase in incident catheter use from 76.8% to 79.1% with a decrease in AVF use from 21.6% to 18.6% over the same time period (Moist, Trpeski, Na, & Lok, 2008).