Vascular access for haemodialysis in Scotland - The Scottish Renal ...

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Vascular access for haemodialysis in Scotland - The Scottish Renal ...

Vascular access forhaemodialysis in Scotland(Provisional)Andrew Henderson, Keith Simpson,Gordon Prescott, Joanne Boyd andAlison Severn, on behalf of the ScottishRenal Registry


Introduction• Widely accepted that a nativearteriovenous fistula is the best form ofvascular access for haemodialysis• Central venous lines are associatedwith a higher risk of bacteraemia andhigher mortality• Dhingra et al., 2001; Kidney Int 60:1443• Pastan et al., 2002; Kidney Int 62:620• Xue et al., 2003; Am J Kidney Dis 42:1013


QIS Standards• Standard 4.4:– A minimum of 70% of HD patients have anarteriovenous fistula or vein graft as theirpermanent access– 2002 Peer Review• 3 of 10 adult units reached target– UK Renal Association Survey 4/2005• 5 of 10 adult units reached target


• Standard 4.5:– Permanent catheters are used ashaemodialysis access in a maximum of20% of patients– Met in 3 of 10 units


Questions• How may HD patients with ERF havefistulas, grafts, tunnelled lines etc?• What are the determinants of accesstype?– gender, age, PRD?• Are there large differences in accesstype between units?


METHODS


Scottish Renal RegistryAudit Census DayConfidential Summary and Data Collection SheetVer 1317 Aug2006The SRR Steering Group has agreed to combine our regular audits of haemoglobin and URR withthe first survey of Vascular Access for patients using hospital or home HD for ERF.Please complete this form for every patient who dialyses in your unit on the census day. Thisincludes patients who are normally registered with another unit but who are dialysing with you onthat day. It also includes all your satellites. An expanded instruction sheet has been sent to eachrenal unit. A copy can be viewed on the SRR Website. Further copies of this document and theinstruction sheet are available on the SRR website http://www.show.scot.nhs.uk/SRR or you canphotocopy a blank form.Once completed please give this form to the person responsible for entering data onto the RenalUnit Electronic Patient Record or the Scottish Renal Registry. They will deal with data entry andthen send the form to the SRR office.Please complete all 7 Sections of this form.1. Patient IDName of Parent Renal Unit eg MonklandsLocation of the HD eg Home or Peterhead…Patient Name : SurnameForenameDate of Birth (dd/mm/yyyy)2. HD DetailsDate of HD reported for this CensusHD Sessions per weekPlease tick the appropriate boxWhat is the planned Duration of this HDsessionHospital Patient ID Label would be ideal here_____/_____/______________/_____/_________1 2 3 4 5 6 7: (hh:mm)What time will (or did) this session start: (hh:mm)3. Today’s Pre dialysis Weight and Blood PressurePlease record the patient’s pre dialysis weight in kg wearinglight indoor clothes without shoes.. kgPlease record the patient’s pre dialysis sitting blood pressure/ mmHg4. Vascular AccessPlease tick one box which best describes the afferent (arterial) access used for HD on the CensusDayFistula: Right LeftVein Loop Right LeftRadiocephalicBrachiocephalicBrachiobasilicUlnacephalicRadioulnarPopliteal to long saphenousAV Fistula details not knownBrachial artery to brachial veinBrachial artery to basilic veinFemoral artery to femoral veinVein Loop details not knownGraft: Right LeftRadial artery to antecubital veinBrachial artery to axillary veinBrachial artery to brachial veinBrachial artery to cephalic veinBrachial artery to basilic veinAxillary artery to axillary veinFemoral artery to femoral veinPopliteal artery to internaljugular veinPopliteal artery to femoral veinAxillary artery to jugular veinFemoral artery to jugular veinFemoral artery to renal veinAV Graft details not knownNeedled but details not known RightNeedles used through the skinbut access type not knownLeftComment: Please only use this box if required toexplain a complex situation that is not covered in thelist above. In that case please add you name so thatwe can contact you for further help if necessaryNon Tunnelled CV Catheters(“Lines”)Non tunnelled internal jugularvein catheterNon tunnelled subclavian veincatheterNon Tunnelled femoral veincatheterNon Tunnelled Line details notknownCommentYour Name:5. URR AuditPlease tick the box below to confirm that you have done or will do the routine April URR samplesas described in the SRR guideline on the Census Day and that you will submit the result to theSRR in the normal way for your unit (eg via Electronic Patient Record). You do not have to enterthe results here.URR Samples taken6. Haemoglobin AuditPlease tick 3 boxes below to confirm that you have or will measure the following as described inthe SRR guideline on Haemoglobin Audit You do not have to enter the results here.Haemoglobin Sample takenSerum Ferritin Sample takenHas the patient had a blood transfusion in the 28 days before the Hb audit sample? Yes No7. Haemopoietic DrugsPlease insert the prescription that is in force for the following medicines on the Census Day.Insert “0” dose for medicines which are not prescribed. A dose or a “0” should be entered in everybox in the dose column.Drug Name Dose Units Frequency RouteExample Epo 1000 u 3 x week Sub cutExample NESP 0Example Iron 75 mg weekly I VComplete BelowEpo (Alfa or Beta, aka Epoetin, Eprex NeoRecormon)NESP (aka Arenesp, Darbepotein Alfa)CERAIron Sucrose, (aka Iron Saccharate, Venofer)Iron Dextran (aka CosmoFer)Iron Sorbitol (aka Jectofer)Now please ensure that this form is returned by your local coordinator as soon as possible to theScottish Renal Registry, Glasgow Royal Infirmary, Walton Building, Glasgow, G4 0SFRightTunnelled CV Catheters Right(“Lines”)LineTunnelled internal jugular veincatheterTunnelled subclavian veincatheterTunnelled femoral vein catheterSubcutaneous Implantedeg “LifeSite”Tunnelled Line details notknownLeftLeft


RESULTS


• 1566 patients• Details of vascular access in 1558patients• 1550 prevalent patients on 5 th April;58% of these were male• Primary renal diagnosis available for1399 patients


Vascular access in Scotland120011101000800Number6004003572000653 716 8Fistula AVG Vein loop Needled NK Tunnelled Non-T MissingAccess type


Types of AV Fistula600517500467400Number300Series12001000464 1Brachiocephalic Radiocephalic Brachiobasilic Radioulnar Popliteal to longsaphenous75Details not known


Access (simplified)373AV accessLine24%76%1185


Access by gender100%90%203080%70%60%50%LineAV40%807030%20%10%0%FemaleMalep


Access in males and females100%90%80%70%60%50%40%Non-TTunnelledNeedled NKVein loopGraftFistula30%20%10%0%FemaleMale


Access and Age100%90%80%70%Number of patients60%50%40%LineAV30%20%10%0%1st(oldest) 2nd 3rd 4thAge quartile


Access by Age and Gender100%90%80%70%60%50%40%Non-TTunnelledNeedled NKGraftFistula30%20%10%0%Older F Younger F Older M Younger M


Access and Primary Renal Disease100%80%60%LineAV40%20%0%GN Interstitial Multisystem Diabetes Unknownp=0.014


Access in patients with Diabetes as PRD100%90%80%70%60%50%LineAV40%30%20%10%0%DNNon-DNp=0.034


Access by Unit100%90%80%70%60%50%LineAV access40%30%20%10%0%Scotland 1 2 3 4 5 6 7 8 9 10 11Unitp


Access by Satellite Unit100%90%80%70%60%50%Line AllAV All40%30%20%10%0%1 2 3 4 5 6 7 8 9 10 11 12 13 Scotland


Satellite Units vs Parent Unit100%90%80%70%60%50%Line AllAV All40%30%20%10%0%Unit A Sat Unit A Unit B Sat Unit B Unit C Sat Unit C Unit D Sat Unit D Unit E Sat Unit E Unit F Sat Unit F


Home Haemodialysis90%85%80%70%60%50%40%30%20%10%0%8%4%2%0%0%Graft Fistula Needled NK Tunnelled Non Tunnelled Missing


Conclusions• Access is dependent on:– Renal Unit– Sex– Primary Renal Disease• The number of units reaching targets isimproving and is now 70% of adult units


Future Work• Association with haemoglobin anderythropoietin data.• Association with URR and dialysis time data.• Grant applied for to allow prospective datacollection to look more fully at vascularaccess practice and impact on outcomes.

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