Reducing Hemodialysis Catheter Use in Prevalent Hemodialysis Patients

Reducing Hemodialysis Catheter Use in in a Prevalent Hemodialysis Population; A Pilot Randomized Control Trial

To determine if a protocolized approach to converting hemodialysis central venous catheters (CVC) to arteriovenous fistulae will improve rates of functioning AVF and decrease CVC use.

In order to receive dialysis, patients require repeated access to their bloodstream. This access can be either via a central venous catheter (CVC) or a surgically created arteriovenous fistula (AVF) or graft (AVG). This is a pilot randomized control trial of prevalent hemodialysis patients with a central venous catheter (CVC), to determine if a systematic approach using an algorithm protocol to convert the CVC to an AVF (arteriovenous fistula) will improve rates of functioning AVF and decrease CVC use. The algorithm (intervention group) will be compared to current practice (control group), a non-standardized approach at the discretion of the caring nephrologist and/or surgeon.

Inclusion Criteria:

• > 18 years of age
• Dialyzing with a CVC
• Receiving hemodialysis three times weekly for > 3 months

Exclusion Criteria:

• Awaiting peritoneal dialysis catheter insertion
• Scheduled living donor transplant
• Transient patients from out of province
• Expected transfer to satellite dialysis unit within 6 months
• Surgical plan for AVF (i.e. scheduled date)
• Documented lack of suitable vasculature for AVF
• Refusing AVF