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Semin intervent Radiol 2009; 26(2): 096-105
DOI: 10.1055/s-0029-1222452
© Thieme Medical Publishers

Dialysis Access in Europe and North America: Are We on the Same Path?

Maurizio Gallieni1 , 2 , Ramesh Saxena3 , Ingemar Davidson4
  • 1Nephrology and Dialysis Unit, S. Paolo Hospital, Milan, Italy
  • 2Department of Medicine, Surgery, and Dentistry, University of Milano, Italy
  • 3Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
  • 4Division of Transplant, Department of Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas, Texas
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Publikationsdatum:
29. Juni 2009 (online)

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ABSTRACT

Large differences in dialysis access exist between Europe, Canada, and the United States, even after adjustment for patient characteristics. Vascular access care is characterized by similar issues, but with a different magnitude. Obesity, type 2 diabetes, and peripheral vascular disease, independent predictors of central venous catheter use, are growing problems globally, which could lead to more difficulties in native arteriovenous fistula placement and survival. Creation of dedicated dialysis access teams, including a vascular access coordinator, is a fundamental step in improving vascular access care; however, it might not be sufficient. The possibility that factors other than patient characteristics and surgical skills are important in determining outcomes is likely; it might explain apparent contradictions of end-stage renal disease (ESRD) practices (kidney transplant, peritoneal dialysis, patterns of vascular access use in hemodialysis), where some countries excel in one area and score poorly in another. We are on the same path, but we have a long way to go.

KEYWORDS

Arteriovenous fistula - hemodialysis - vascular access - catheter - graft

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Maurizio GallieniM.D. 

Department of Medicine, Surgery, and Dentistry, University of Milano

Via di Rudini, 8, 20142 Milano, Italy

eMail: maurizio.gallieni@unimi.it