Grant: Operating Grant

Patients with kidney failure have a high risk of adverse health outcomes and are very expensive to care for. Most patients are treated with hemodialysis, which requires access to the bloodstream, called "vascular access". While vascular access is a lifeline, it is also the cause of many complications and invasive procedures. The two most common forms of vascular access are "fistulas" and "catheters". Many physicians and expert committees consider fistulas the preferred form of vascular access and actively promote them, but this is based on studies that have important limitations. In fact, early data from our group suggests that many fistulas never work and some patients who decide to have a fistula created have a higher rate of complications. Finally, patients' views of their vascular access and how they impact on the quality of their lives has not been adequately studied and is an important consideration. We plan to conduct a study that will compare the risk of complications in patients who use a fistula for vascular access to those who use a catheter. We will also explore the impact of their vascular access on quality of life. We have taken a number of steps to prepare for this research project, have a network of sites interested in participating, expertise in the care of dialysis patients, and a strong track record of research in this area. The findings of this study will have important implications for patients, doctors, and decision makers since we will ensure that appropriate efforts to increase fistula use do not have unintended consequences for patients or lead to increased resource use and costs.