Reducing Hemodialysis Catheter Use in Prevalent Hemodialysis Patients

Study Overview
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Brief Summary
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To determine if a protocolized approach to converting hemodialysis central venous catheters (CVC) to arteriovenous fistulae will improve rates of functioning AVF and decrease CVC use.

Detailed Description
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In order to receive dialysis, patients require repeated access to their bloodstream. This access can be either via a central venous catheter (CVC) or a surgically created arteriovenous fistula (AVF) or graft (AVG). This is a pilot randomized control trial of prevalent hemodialysis patients with a central venous catheter (CVC), to determine if a systematic approach using an algorithm protocol to convert the CVC to an AVF (arteriovenous fistula) will improve rates of functioning AVF and decrease CVC use. The algorithm (intervention group) will be compared to current practice (control group), a non-standardized approach at the discretion of the caring nephrologist and/or surgeon.

Official Title
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Reducing Hemodialysis Catheter Use in in a Prevalent Hemodialysis Population; A Pilot Randomized Control Trial

Conditions
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Hemodialysis

Intervention / Treatment
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* Other: Protocolized approach to convert dialysis catheter to fistula


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: > 18 years of age Dialyzing with a CVC Receiving hemodialysis three times weekly for > 3 months Exclusion Criteria: Awaiting peritoneal dialysis catheter insertion Scheduled living donor transplant Transient patients from out of province Expected transfer to satellite dialysis unit within 6 months Surgical plan for AVF (i.e. scheduled date) Documented lack of suitable vasculature for AVF Refusing AVF

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Protocolized approach<br>Protocolized approach to convert catheter to arteriovenous fistula | Other: Protocolized approach to convert dialysis catheter to fistula<br>* This group will be assigned an algorithm protocol in efforts to convert the central venous catheter to an arteriovenous fistula. A case manager will be assigned to follow these patients and implement the protocol<br>|
| No Intervention: Current Care Model<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of patients using a CVC in a prevalent hemodialysis population after the implementation of an algorithm protocol to convert the CVC to an AVF compared with patients who received current standard care. |  | 9 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of patients with a functioning AVF after the implementation of an algorithm protocol to convert the CVC to an AVF compared with patients who received current standard care. |  | 9 months | 
| Proportion of patients with a maturing AVF |  | 9 months | 
| Primary fistula failure rate |  | 9 months | 
| Incidence of AVF salvage procedures, including balloon angioplasty and accessory vein ligation, within 9 months of AVF creation |  | 9 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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central venous catheter, arteriovenous fistula, hemodialysis, vascular access, dialysis