Results of the implementation of a triage system of vascular access performance in haemodialysis patients: experience of a single dialysis centre.

Abstract

Routine systems for monitoring vascular access (VA) performance are lacking. We developed a vascular accesstriage system to evaluate the monthly performanceof the access, developed a specific score and assessed the association betweenscore improvement and clinical outcomes. Vascular access was triaged (Green, Yellow or Red) according to a score generated by dialytic and clinical parameters in all patients who, from 1/1/2014 to 31/03/2014, had been receiving haemodialysis treatment for at least 3 consecutive months in our Unit and who were then followed up for 4 years. We enrolled 130 patients, 78 with arteriovenous fistula (AVF) and 52 with tunnelled central venous catheter (CVC). During a median of29 ± 11months of follow up (range 3-46months), 28 deaths and 303 hospitalizations (lasting 16 ± 30days) were recorded. Vascular accesstriagescores improved over time(2014 vs 2015 vs 2016 vs 2017) in the population with an AVF(Green from 25% to 58% to 77% to 79%, Yellow from 65% to 39% to 18% to 20% and Red from 10% to 3% to 5% to 1%, respectively; χ2 p < 0.01) but not in the CVC group (Green 58% to 57% to 80% to 92%; Yellow 37% to 36% to 20% to 8%; Red 5% to 7% to 0%; χ2 = n.s). Blood pressure and dialysis efficiency improved in the population as a whole and in the two subgroups (AVF and CVC) separately. AVF and CVC populations, stratified separately according to median VA score, had different event-free follow-up, which was higher (p = 0.0085) in patientswith lower scores in the AVF population only. The vascular accessmonitoring system improved the vascular accessscore as well as someclinical and dialytic parameters. Green triage in AVF patients identify those with better outcomes, in agreement with the commonly recognized clinical value of a well-functioning vascular access.