Background: Little is known about the targets and expectations of practicing nephrologists with regard to timing of preemptive AV access surgery and how these relate to actual observed practice patterns in clinical care. Methods. We administered a 8-question survey to assess nephrologists' expectations for preemptive vascular access placement to 53 practicing nephrologists in California. We performed a retrospective chart review of 116 patients who underwent preemptive vascular access placement at a large academic medical center and examined progression to ESRD. Results: According to our survey of nephrologists, most aimed to have preemptive vascular access created about 6 months prior to start of ESRD or when the chances of ESRD within the next year is two-thirds or greater. The estimated GFR level at which they believe match these conditions is approximately 18 ml/min/1.73 m2. Among the 116 patients with CKD who underwent preemptive vascular access creation, the mean estimated GFR at the time of access creation was 16.1 (6.8) ml/min/1.73 m2. Only 57 out of the 116 patients (49.1%) patients initiated maintenance HD within 1 year after surgery. Conclusions: In our study, most nephrologists aim for preemptive vascular access surgery approximately 6 months prior to the start of HD. However in fact, only approximately 50% of patients who underwent preemptive vascular access surgery started HD within 1 year. Better tools are needed to predict the natural history of advanced CKD.
Bibliographical noteFunding Information:
We would like to thank Dr. Joachim Ix of UC San Diego and Dr. Brigitte Schiller of Satellite Dialysis for facilitating the surveys. Supported by the National Institutes of Health K23DK88865 (Dr. Bansal), K24 DK85153 (Dr. Johansen), K24 DK92291 (Dr. Hsu) and UCSF Resource Allocation Program for Trainees Pathways Explore Summer Fellowship (Mr. Murphy).
- Advanced CKD