WHAT FACTORS AFFECT FISTULA PREVALENCE IN DIALYSIS PATIENTS?
Practice patterns can have a major impact on the prevalence of patients dialyzing with fistulas. In a landmark study Hirth et al reported substantial geographic variations in the prevalence of fistulas among new dialysis patients within the United States, ranging from a high of 77% in New England to a low of 15% in the Southeast14. Similarly, analysis of a cohort of 1824 patients enrolled in the HEMO Study at 45 American dialysis units found substantial geographic variations15. The prevalence of fistulas was 45.3% in the Northeast, but only 30.6% in the Southeast. In both reports, these geographic differences persisted even after adjustment for multiple demographic factors and co-morbid conditions. Variations in the type of vascular access are also reflected in the 2000 Annual Report of ESRD Clinical Performance Measures16. During the fourth quarter of 1999, 27% of U.S hemodialysis patients were using fistulas. The prevalence of fistulas varied greatly among the 18 networks, ranging fr
