Optimal access in dialysis – a novel metric in FHA renal

Optimal access in dialysis – a novel metric in FHA renal

The Fraser Health renal program has been working tirelessly the last several years to optimize dialysis for our patients.

While we encourage patients to pursue independent dialysis if it works with their wishes, beliefs and values, we recognize that many patients will elect to start dialysis on hemodialysis as their preferred modality.

Some of the best observational data suggests that HD with a permanent access is just as good as PD, in terms of mortality.

 
Perl J, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y, Jassal SV, Moist L. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011 Jun;22(6):1113-21. PMID: 21511830.

 

 

Perl Vascular Access

At FHA, we believe that our AV access rate among our HD patients isn’t a primary metric of success. ¬† Rather, it’s the percentage of all dialysis patients who start and continue dialysis without a central venous catheter that matter. ¬†Essentially, a program’s success in supporting patients to do peritoneal dialysis shouldn’t negatively impact the program’s overall performance metrics.

So, the novel metric we’ve been tracking, the “optimal access rate” has been:

[AVF + AVG + PD]/all dialysis patients

Since we’ve launched 2 simultaneously strategies to improve permanent access rates and independent dialysis, we’re seeing consistent increases in our “optimal access” rates.

Choice of modality on dialysis

 

We’ll continue to track permanent access rates in our hemodialysis units, but we strongly believe the ‘optimal access’ rate is the most meaningful benchmark to assess performance at a program level.