Vascular Access Audit Report

This is the second time that the kidney community in England has been asked about the types of vascular access used by patients receiving haemodialysis. There is clearly still work to do, but it is evidence of just how committed kidney units are to their patients’ vascular access that so many centres have responded again this time.

The first report contained data from the first six months of 2010. This report is more ambitious and contains data on all patients who started on dialysis during 2011. It sets the foundations for a regular collection of vascular access to allow continuous audit of patients in the future. The timely creation of definitive dialysis access is a matter of careful judgement. The progressive decrease year-on-year of patients who present late requiring dialysis, coupled with the recent introduction of patient decision aids to support shared decision making, should improve experience and outcomes for patients and help clinicians in planning a timely dialysis start.

This report was collected using a spreadsheet rather than automated direct electronic capture, to which many units responded by asking “why can this not be done by direct electronic extraction?” So that’s the plan from now on – it will be part of the general return of information to the UK Renal Registry. We may not have solved the issue of vascular access for our patients, but the likelihood of dialysing with an AV fistula or graft has increased to 77.6% in the centres which submitted data in both audits (2005 and 2011 data). Some regions are doing better than others, so we need to ask ourselves what and how can we learn from our colleagues? Improving on a national figure of only
43% of patients starting haemodialysis via an AVF and AVG needs to be reviewed by each and every kidney
team in the country.

I congratulate all those involved in this important audit and thank them for their efforts, particularly staff at
the UK Renal Registry and NHS Kidney Care.

Is there scope to improve? Yes – there is.

Will we achieve improvement? Yes – we are now measuring access for dialysis and we will remain focused on patient choice, and then support patients to achieve their goals, be that dialysis requiring timely formation access, conservative kidney care, or pre-emptive renal transplantation.

Donal O’Donoghue