The success of Fistula First nationwide has been accompanied by an unplanned increase in hemodialysis catheters. Complications related to prolonged hemodialysis catheter use include increased morbidity, mortality, and cost. We hypothesize that the national focus on increasing fistulas may have inadvertently diverted attention away from initiatives to decrease dependence on hemodialysis catheters. Based on a synthesis of guidelines, reviews, published evidence, and the authors' opinions, we propose that the national vascular access initiative be revised to have a dual goal of Fistula First and "Catheters Last." These goals are not mutually exclusive, but rather complementary. We recommend a systematic refocus on interventions that not only increase fistulas, but help avoid extended catheter use. Clearly, the ideal practice for hemodialysis vascular access remains early placement of fistulas with enough maturation time such that they can be used for initiating long-term hemodialysis therapy when the need arises. To effect this change, a reimbursement policy covering the costs associated with permanent access placement before the need for dialysis is essential. Individualized patient management strategies may consider such innovat...Continue Reading
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Prosthetic arteriovenous fistulas and venous anastomotic stenosis: influence of a high flow velocity on the development of intimal hyperplasia
Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography
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Venous stenosis and thrombosis associated with the use of internal jugular vein catheters for hemodialysis
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Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations
Description of a new surveillance system for bloodstream and vascular access infections in outpatient hemodialysis centers
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Patient dialysis knowledge is associated with permanent arteriovenous access use in chronic hemodialysis.
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Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications
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More than reducing early fistula thrombosis is required: lessons from the Dialysis Access Consortium clopidogrel fistula study
What's next after fistula first: is an arteriovenous graft or central venous catheter preferable when an arteriovenous fistula is not possible?
Unrecognized high brachial artery bifurcation is associated with higher rate of dialysis access failure
Comparison of the palindrome vs. step-tip tunneled hemodialysis catheter: a prospective randomized trial
A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China
Can serum NGAL levels be used as an inflammation marker on hemodialysis patients with permanent catheter?
The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees
Arteriovenous grafts are associated with earlier catheter removal and fewer catheter days in the United States Renal Data System population
"Two is better than one": a composite graft made of two different vascular prostheses for urgent hemodialysis access in a troublesome case
Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons
The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access.
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