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A new and improved way to time vascular access points for kidney patients

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A new study suggests a commonly used tool called the Kidney Failure Risk Equation (KFRE) can be used to support timely creation of vascular access points, such as fistulas, for kidney patients. The results could eventually lead to fewer unnecessary surgeries and increased quality of life and outcomes.

Hemodialysis is a life-saving treatment for people experiencing kidney failure, but the process involves repeated needle insertion several times per week. Therefore, patients who will require long-term dialysis need surgery to create vascular access (VA) points, such as a catheter port or fistula (a thickened knot of veins that can better withstand repeated needle insertion).

However, timing these surgeries can be very challenging, notes Mohammad Atiquzzaman, a research scientist with BC Renal. “Vascular access points take a little bit of maturation time, so we don’t want to delay the procedure too much. At the same time, we don’t want to create it too early because that has an impact on the patient’s quality of life and the process is resource intensive,” he explains.

In a study published in the Clinical Kidney Journal, Atiquzzaman and his colleagues explored how the KFRE might support better timing of VA procedures. Currently, doctors use a common measurement of kidney function, called eGFR, as a threshold for VA initiation. However, the KFRE includes this measurement plus a variety of other factors to predict whether a patient is likely to experience kidney failure in the following two or five years.

In their study, the researchers analyzed data from more than 2,500 kidney patients in British Columbia, who went through the current referral system to get their VA created. The researchers investigated what would happen if KFRE score was considered in addition to the current system.

The results show that using the KFRE can increase the portion of patients correctly referred to get VA (meaning they had a VA point created and used it within two years) from 49% to 58%. At the same time, the tool was able to decrease the number of patients who had VA access created unnecessarily (meaning they had a VA point created but did not need it within the following two years) from 31% to 18%.

These findings suggest that the KFRE is useful for deciding when VA points are created for patients. “If we utilize this KFRE in this way, then we can optimize the timing and expect better clinical outcomes for patients,” says Atiquzzaman. 




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