Grant: Project Grant

Hemodialysis requires a reliable method of connecting the patient to the blood-purification machine, called vascular access. The two most common forms of vascular access are catheters and fistulas. A catheter is a plastic tube inserted into a vein in the neck; a fistula is a vein surgically connected to an artery in the arm that is accessed by needles. Many expert committees consider fistulas the preferred form of vascular access and actively promote them. However, these recommendations are based on studies that may have overestimated the benefits of fistulas and underestimated the potential risks associated with procedures required to achieve and maintain fistula patency. We do not have sufficient data to provide patients with enough information to allow them to make an informed decision about pursuing a fistula creation attempt or using a hemodialysis catheter without attempting a fistula. We cannot offer decision support to promote shared decision-making because we do not know patient, caregiver and healthcare provider decision needs. We will study people who start hemodialysis with a catheter in six large renal programs in Canada. We will follow participants from the start of hemodialysis to determine the benefits and harms associated with attempting fistula creation, and whether they vary with sex, age or presence of disease conditions. We will also assess decision needs of patients and caregivers, and healthcare providers. This project will leverage multicenter, high-quality data describing vascular access procedures and our expertise in this area of research. We will provide important data on potential benefits and possible harms of attempting or avoiding fistulas and will identify the attributes of hemodialysis access-related decisions that are important to patients and caregivers, and healthcare providers in order to inform the design of a tool to support decision-making about the vascular access for hemodialysis.