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DOPPS data raise concerns about fistula placement

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Researchers from the Dialysis Outcomes and Practice Patterns Study Practice Monitor will present new outcomes data on vascular access techniques in the United States at a WebEx conference on May 3.

Ronald Pisoni, PhD, MS, deputy principal investigator for the Dialysis Outcomes and Practice Patterns Study (DOPPS), will present findings about a trend in United States about arteriovenous fistula (AVF) placement.

“Generally, placing the AVF in the lower arm is preferred as there is less risk of exhausting available sites for future AVFs,” according to a DOPPS press release about the program. “Yet between 1996 and 2015, researchers saw a large shift in the U.S. from lower to upper arm AVFs, raising serious concerns about the long-term implications for dialysis care for these patients. The discussion will address important questions regarding what is best practice and how it is best achieved to optimize vascular access outcomes.”

The Practice Monitor is based in the United States on a sample of more than 9,000 patients in more than 160 hemodialysis facilities, and has now expanded to provide data from Canada, Germany and the Gulf Cooperation Council countries.

Researchers will also present an overview of U.S. hemodialysis trends from the Practice Monitor on ultrafiltration rates among U.S. providers.

“UFR values 13 ml/kg/hr have been associated with increased cardiovascular morbidity and mortality,” according to the release. “The reporting of UFR values will be a new ESRD Quality Incentive Program (QIP) measure beginning in Program Year 2020.” Trends in ultrafiltration rates from August 2010 through February 2018 will be presented.

DOPPS researchers will also look at the use of the drugs patiromer and etelcalcetide in its U.S. sampling. Patiromer is a new potassium-binding agent approved in 2015, and etelcalcetide is an IV calcimimetic approved in 2017. Hugh Rayner, MA, MD, FRCP, DipMedEd, country investigator for the DOPPS in the United Kingdom, will also present findings on pruritus in patients on hemodialysis.

“Although the percentage of patients on hemodialysis very much or extremely bothered by itching has been decreasing over the last 2 decades, it remains underestimated by a majority of clinicians,” according to the release. The discussion will focus on how awareness and treatment of pruritus can be improved.

Reference: https://cc.readytalk.com/registration/#/?meeting=7jnqp89ztgub&campaign=svfc9ybao2t9