A community-based nephrology practice experience

as a permanent access. 3 A multidisciplinary vascular access care program established by Gambro Healthcare has proven effective in implementing the National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) guidelines for vascular access. Since 1996, a multidisciplinary team approach has been used in our Renal Care Group dialysis program in the Olympia, Wash., area to increase the use of AV fistulae. The program has been successful. A recent review of Olympia-area d/ialysis patients showed that 98% of our patients have an AV fistula, with 87.7% of patients using the AV fistula for dialysis access and 10.2% using an HD catheter until the AV fistula matures. All AV grafts have been converted into secondary AV fistulae over a four-year period, and we have greatly reduced the use of HD catheters. 5 Although the multidisciplinary program was developed in a small community-based nephrology practice, this type of approach toward the creation of optimal HD accesses was adopted by the Nort h west (NW) Renal Network (#16) in 2002 as the basis for the Netwo r k ’s Quality Improvement Program (QIP) for vascular access, mandated by the Centers for Medicare & Medicaid Services (CMS) to increase the use of AV fistulae as d i a lysis accesses at facilities within the Netwo r k .