Rich Mishler, MD, Arizona Kidney Disease & Hypertension Center and Don Schon, MD, Arizona Kidney Disease & Hypertension Center

A large community nephrology group in the Southwest established a screening program and access intervention laboratory for the maintenance of dialysis vascular access in patients with end stage renal disease (ESRD). Screening was done with the Transonic HD01 ultrasound dilution technique. Patients whose graft blood flow fell below 600 cc/min or decreased >25% were referred for angiogram and, if indicated angioplasty. Patients were referred to either the nephrology run access intervention center (AIC) or community facilities as dictated by their insurance.

Results on 78 randomly selected patients sent to each type of facility were compared. Patients were matched for age, gender, and diabetic status. The mean age was 55.7 years in the AIC group and 53.4 years in the community group. 55.7% and 53.4% female, respectively and 62% diabetic in both groups. Patients in the AIC treated group were significantly less likely to be hospitalized than those treated in the community group (9.7% vs. 48%, p=<.01). Hospital days per procedure in the AIC group was 0.391 compared to 3.14 for the community group (p=<.01). Length of stay for those hospitalized was not significantly different between groups (4.3 vs. 4.1 respectively, p=.03). The initial angioplasty success rate was 88% for the AIC group vs. 68% for the community which was statistically significant (p<.01).

Conclusion: A dedicated nephrology run access intervention center in an outpatient setting can produce improved outcomes along with decreased rate of hospitalization in the ESRD patient.