Mid-Atlantic Renal Coalition, Richmond, Virginia, USA.
Curr Opin Nephrol Hypertens. 2011 Nov;20(6):583-92. doi: 10.1097/MNH.0b013e32834b33c4.
This review summarizes the background and implementation of the Fistula First Breakthrough Initiative (FFBI), published information about changes in vascular access practice since its inception, and several issues raised by the program.
The FFBI is a surveillance system using the End-Stage Renal Disease (ESRD) Networks to spread improvement ideas. Concomitant with implementation of the program, prevalent arteriovenous fistula use has increased an average of 3.3% annually since 2003, an incremental improvement of 1.3% over the preexisting trend. At the same time, long-term central venous catheter (CVC) use declined among the prevalent population. Increasingly, individual facilities are achieving the FFBI goal of 66% prevalent arteriovenous fistula use; however, results vary across geographic regions and are not explained by patient demographic and clinical characteristics alone.
ESRD Network interventions as a function of the FFBI are associated with increasing arteriovenous fistula use and likely contributed to improvement, but improvement cannot be unequivocally attributed to the Networks due to lack of rigorous research design. Questions and opportunities remain. It is not yet clear how to identify patients who may not be appropriate candidates for an arteriovenous fistula. The ultimate impact of the FFBI on patient mortality is yet to be determined. The FFBI must continue to identify variations in use and the contributing causes, and implement strategies to address these causes if the FFBI goal is to be fully achieved.
本综述总结了瘘管优先突破性倡议（FFBI）的背景和实施情况，介绍了该倡议实施以来血管通路实践的变化情况，以及该倡议引发的若干问题。
FFBI 是一个使用终末期肾病（ESRD）网络传播改进理念的监测系统。自 2003 年以来，该倡议实施的同时，动静脉瘘的普遍使用率每年平均增加 3.3%，比现有趋势提高了 1.3%。与此同时，长期中心静脉导管（CVC）的使用在流行人群中下降。越来越多的单个医疗机构实现了 FFBI 66%的动静脉瘘使用率目标；然而，结果因地理区域而异，不能仅用患者人口统计学和临床特征来解释。
作为 FFBI 的一部分，ESRD 网络干预措施与动静脉瘘使用率的增加有关，并可能促成了这一改善，但由于缺乏严格的研究设计，不能将改善明确归因于网络。仍存在疑问和机会。目前尚不清楚如何识别可能不适合动静脉瘘的患者。FFBI 对患者死亡率的最终影响仍有待确定。如果要全面实现 FFBI 目标，FFBI 必须继续识别使用情况的差异及其原因，并实施策略来解决这些原因。
