Kidney Week

Abstract: FR-PO515

Patient and Provider Perspectives Surrounding Arteriovenous Fistulas vs. Grafts: A Qualitative Substudy of the AV Access Trial

Session Information

• Dialysis Vascular Access
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Patel, Dipal M., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Dipal M. Patel, MD, PhD

• White, Katherine Elaine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Katherine Elaine White, MD

• Chandler, Allison, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Allison Chandler, PhD

• Strahley, Ashley E., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Ashley E. Strahley, MPH

• Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews, MD, ScM, FASN

• Murea, Mariana, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Mariana Murea, MD, FASN

Background

People with kidney failure on hemodialysis (HD) require sustainable vascular access. While the “Fistula First” initiative recommended arteriovenous fistulas (AVF) as the optimal access for all people on HD, AV grafts (AVG) may have similar outcomes in select populations such as older adults who more commonly experience AVF maturation failure. The AV Access trial is a randomized controlled trial studying outcomes of adults > 60 years old with > 1 major comorbidity, on chronic HD with a tunneled catheter, who are then randomized to receive an AVF or AVG. Patient recruitment for this trial has been slower than anticipated. We sought to explore perspectives of relevant stakeholders surrounding the perceived optimal access for HD, and to assess the implications of these perspectives on trials of AV access.

Methods

We planned focus groups with site investigators and individual semi-structured interviews with nephrology providers, vascular access surgery providers, and older adults on HD who were approached for enrollment in the AV Access trial. Thematic analysis was used to analyze data.

Results

Two focus groups (n= 4 nephrology and 4 vascular access surgery site investigators), and 31 semi-structured interviews (n=10 nephrology providers, 9 vascular access surgery providers, and 12 eligible patients) were conducted. We identified three common themes of participant perspectives (Table).

Conclusion

Prioritizing AVF placement in all patients on HD is pervasive. Educational initiatives aimed at increasing patient and provider knowledge of potential equipoise between AVF and AVG in select populations, as well as patient-centered practices, may enable patient enrollment in trials studying dialysis vascular access.

Themes and exemplary quotations.

Funding

• NIDDK Support