Wish Jay B
Division of Nephrology, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
Semin Dial. 2010 Nov-Dec;23(6):614-8. doi: 10.1111/j.1525-139X.2010.00797.x. Epub 2010 Dec 20.
In 2003, the Centers for Medicare and Medicaid Services (CMS) made an increase in arteriovenous fistula (AVF) prevalence and a decrease in catheter prevalence a priority, initiating a project known since 2005 as the Fistula First Breakthrough Initiative (FFBI). From 2003 to June 2010, the prevalent AVF in use rate has increased from 32.2% to 55.8% according to CMS data, a remarkable achievement yet short of CMS's 66% prevalent AVF goal. The prevalent catheter rate decreased from 26.9% to 23.8% during this same period. Although an effort to augment AVF placement has resulted in issues of nonmaturation, the primary contributor to the 23.8% prevalent catheter rate is the 82% incident catheter rate, which has not declined significantly. Future efforts to decrease the prevalent catheter rate and increase the prevalent AVF rate must be directed at patients with stages 4 and 5 chronic kidney disease and the healthcare providers and practitioners involved in their care, including hospital systems, surgeons, referring physicians, and nephrologists. The nephrologist plays a key role in providing guidance to those providers and holding them accountable for improved vascular access outcomes.
2003年，医疗保险和医疗补助服务中心（CMS）将提高动静脉内瘘（AVF）普及率和降低导管普及率作为优先事项，启动了一个自2005年起被称为“内瘘优先突破倡议”（FFBI）的项目。根据CMS的数据，从2003年到2010年6月，在用AVF的普及率从32.2%提高到了55.8%，这是一项了不起的成就，但仍未达到CMS设定的66%的AVF普及目标。同期，导管普及率从26.9%降至23.8%。尽管增加AVF植入的努力导致了未成熟问题，但23.8%的导管普及率的主要原因是82%的导管发生率，该发生率并未显著下降。未来降低导管普及率和提高AVF普及率的努力必须针对4期和5期慢性肾病患者以及参与其护理的医疗保健提供者和从业者，包括医院系统、外科医生、转诊医生和肾病专家。肾病专家在为这些提供者提供指导并让他们对改善血管通路结果负责方面发挥着关键作用。
