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Tytuł:
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Timing of referral for vascular access for hemodialysis: Analysis of the current status and the barriers to timely referral.
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Autorzy:
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Kim SM; Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea.
Han A; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Ahn S; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Min SI; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Ha J; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Joo KW; Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Min SK; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Źródło:
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The journal of vascular access [J Vasc Access] 2019 Nov; Vol. 20 (6), pp. 659-665. Date of Electronic Publication: 2019 Apr 08.
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Typ publikacji:
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Comparative Study; Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2018- : Thousand Oaks, CA : Sage Publications
Original Publication: Milano ; Birmingham : Wichtig, c2000-
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MeSH Terms:
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Arteriovenous Shunt, Surgical*
Catheterization, Central Venous*
Referral and Consultation*
Renal Dialysis*
Time-to-Treatment*
Adult ; Aged ; Aged, 80 and over ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Patient Compliance ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Treatment Refusal
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Contributed Indexing:
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Keywords: Hemodialysis; arteriovenous fistula; referral
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Entry Date(s):
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Date Created: 20190409 Date Completed: 20200224 Latest Revision: 20220411
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Update Code:
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20240105
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DOI:
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10.1177/1129729819838132
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PMID:
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30958094
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Introduction: Current guidelines recommend the placement of vascular access 6 months before the anticipated start of hemodialysis therapy; however, many patients start hemodialysis using a central venous catheter. We investigated the timing of referral for vascular access, the vascular access type at hemodialysis initiation, and the barriers to a timely referral.
Methods: The study involved a retrospective review of 237 patients for whom the first vascular access for hemodialysis was created between January and November 2017.
Results: Among the 237 patients, 58.2% were referred before hemodialysis initiation, while 41.8% were referred after hemodialysis initiation. Among the 138 patients, 55, 59, and 24 patients were referred more than 6 months, between 2 and 6 months, and within 2 months before hemodialysis initiation, respectively. Within these subgroups, 3.6%, 10.2%, and 75.0% patients underwent hemodialysis initiation with a central venous catheter, respectively. Among the 99 patients referred after hemodialysis initiation, the reasons for late referral were as follows: unexpected rapid progression of kidney disease (n = 23), noncompliance (n = 21), late visit to the nephrologist (initial visit within 2 months of hemodialysis initiation; n = 14), change of treatment strategy from peritoneal dialysis or transplants (n = 9), and unknown reasons (n = 32).
Conclusion: Only 23% of patients were referred for vascular access 6 months before the anticipated hemodialysis therapy. In addition, 53% of patients initiated hemodialysis with a central venous catheter. Avoidance of catheter insertion was mostly successful in patients referred 2 months before hemodialysis initiation. The most common modifiable barrier to the timely referral was noncompliance.