Optimal Vascular Access Choice for Patients on Hemodialysis

Skandari, M. Reza; Shechter, Steven M.; Zalunardo, Nadia
October 2015
Manufacturing & Service Operations Management;Fall2015, Vol. 17 Issue 4, p608
Academic Journal
Which vascular access to use is considered one of the most important questions in the care of patients on hemodialysis (HD). An arteriovenous fistula (AVF) is often considered the gold standard for delivering HD due to better patient survival, higher quality of life, and fewer complications. However, AVFs have some limitations: they require surgery, it takes approximately three months to know whether the surgery was successful, and a majority of these surgeries end in failure. Conversely, another common vascular access, the central venous catheter, can be inserted via a simple procedure and used immediately after placement. In this research, we address the question of whether and when to perform AVF surgery on incident and established HD patients, with the aim of finding individualized policies that maximize a patient's probability of survival and remaining quality-adjusted life expectancy. Using a continuous-time dynamic programming model and under certain data-driven assumptions, we establish structural properties of the optimal policy for each objective. We provide further insights for policy makers through our numerical experiments.


Related Articles

  • Vascular access for hemodialysis in children. Brittinger, Wolf Dieter; Walker, Gottfried; Twittenhoff, Wolf-Dieter; Konrad, Norbert // Pediatric Nephrology;1997, Vol. 11 Issue 1, p87 

    In the light of many years' experience in hemodialysis access surgery, the different methods of creating vascular access for dialysis treatment in the pediatric population are described. After presenting the various access types using autologous blood vessels and also heterologous grafts, their...

  • Two-stage superficialization of the wrist native AV fistula.  // Kidney;Sep/Oct2002, Vol. 11 Issue 5, p215 

    Presents a summary of the study 'Superficialization of the Wrist Native Arteriovenous Fistula for Effective Hemodialysis Vascular Access Construction,' by W. Weyde et al., from a 2002 issue of the 'Kidney International.'

  • Surgery for Chronic Renal Failure Patients: Trends, Outcomes and Complications. Al-Agha, Rani; AlSahaf, Fatima; Khalaf, Majeed; Gopalan, Nair // Bahrain Medical Bulletin;Dec2014, Vol. 36 Issue 4, p105 

    Background: Vascular access surgery is needed for chronic renal failure patients who require regular hemodialysis to sustain their lives. Access surgery could be central line, graft fistula and native arteriovenous fistula (AVF), the latter has the best outcome in terms of least complication and...

  • Hemodialysis Vascular Access and Complications. Al-Wakeel, Jamal; Huraib, Sameer; Mitwalli, Ahmed; Abu-Aisha, Hassan; Al Mofti, Adnan; Faqih, Saad; Al Salman, Mosaad; Ali Memon, Nawas // Vascular Surgery;Mar1994, Vol. 28 Issue 2, p107 

    From January, 1985, to July, 1991, 105 uremic patients had 148 vascular accesses for chronic hemodialysis. Thirty-three (31.4%) patients received more than one access. Of 148 accesses, 131 (88.5%) were arteriovenous (AV) fistulae and 17 (11.5%) were AV grafts. The mean hospital stay for patients...

  • Vascular access for hemodialysis: an experience report. Centofanti, Guilherme; Fujii, Eliane Y.; Cavalcante, Rafael N.; Bortolini, Edgar; de Abreu, Luiz Carlos; Valenti, Vitor E.; Pires, Adilson C.; Junior, Hugo Macedo; Yamazaki, Yumiko R.; Audi, Soraya G.; Cisternas, Jose R.; Breda, Joao R.; Pereira, Valdelias X.; Fujiki, Edson N.; Correa, João A. // HealthMed;2011 Supplement 1, Vol. 5, p1959 

    Background: The evaluation of dialysis services is important for its adequacy and improvement in patient's quality of life. We evaluated the profile of vascular access used for hemodialysis patient in our Unit. Methods: We evaluated 164 patients of both genders aged over 18 years old who have...

  • Type of vascular access and mortality in U.S. hemodialysis patients. Dhingra, Rajnish K.; Young, Eric W.; Hulbert-Shearon, T.E.; Leavey, Sean F.; Port, Friedrich K. // Kidney International;Oct2001, Vol. 60 Issue 4, p1443 

    Type of vascular access and mortality in U.S. hemodialysis patients. Background. Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality....

  • Hemodialysis Vascular Access: How Do Practice Patterns Affect Outcomes? Pile, Cindy // Nephrology Nursing Journal;May/Jun2004, Vol. 31 Issue 3, p305 

    There are significant international differences in the type of vascular accesses that are routinely used in the hemodialysis population. Most U.S. hemodialysis patients dialyze with grafts or catheters, while most European and Japanese patients dialyze with the preferable native arteriovenous...

  • Factors associated with the prevalence of arteriovenous fistulas in hemodialysis patients in the HEMO Study. Allon, Michael; Ornt, Daniel B.; Schwab, Steven J.; Rasmussen, Cynthia; Delmez, James A.; Greene, Tom; Kusek, John W.; Martin, Alice A.; Minda, Sharon // Kidney International;Nov2000, Vol. 58 Issue 5, p2178 

    Describes the factors associated with the prevalence of arteriovenous fistulas in hemodialysis patients in the United States. Causes of morbidity, hospitalization and cost for chronic hemodialysis patients; Types of vascular access; Differences in the vasculature between blacks and whites.

  • History of medicine.  // Clinical & Investigative Medicine;Aug97 Supplement, Vol. 20, pS35 

    Presents an abstract of the research manuscript `The history of vascular access for hemodialysis: James E. Cimino and the arteriovenous fistula,' by E. Everson and F. Sutherland from the University of Calgary.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics