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, or 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 physician consider fistulas the preferred form of vascular access and actively promote them, but this is based on low quality evidence that has important limitations. There is the potential that we are promoting a therapy that may be harmful to some patients and could lead to increased resource use and costs. We plan to compare the risk of complications in patients who use a fistula for vascular access to those who use a catheter. Our study will address many of the shortcomings of previous studies in an attempt to take a more objective look at the relative merits of catheters and fistulas. We will also look at special groups of patients where the benefits of having a fistula created may not be clear. We have taken a number of steps to prepare for this research project, have access to unique data holdings that allow us to answer this question, are experts in the care of dialysis patients, and have a strong track record of research in this area. In addition, we have already secured funding to cover a portion of this project. Our findings will have important implications for patients, doctors, and decision-makers. The information gathered will allow us to better educate patients about the likely consequences of choosing a particular form of vascular access and we will ensure that that efforts to increase fistula use do not have unintended consequences for patients and do not lead to increased resource use and costs.