AVE
Vascular Access for Hemodialysis
The AVE project is an observational study dedicated to patients with Chronic Kidney Disease, with the aim of implementing an innovative methodology for the monitoring of vascular accesses in haemodialysis patients.
The project
Patients with stage V chronic kidney disease (CKD), according to the Kidney Disease Outcomes Quality Initiative (K-DOQI) classification, require adequate vascular access in order to undergo haemodialysis treatment.
Vascular access is widely recognised as the lifeline of the haemodialysis patient.
There are three types of vascular access for haemodialysis: native arteriovenous fistula (AVF) created using the patient's own vessels; prosthetic AVF (graft) created using synthetic or semi-biological material; and Central Venous Catheters (CVC).
According to the NKF-KDOQI guidelines and the European Best Practice Guidelines (EBPG), native AVF should be present in at least 50% of incident dialysis patients, keeping the use of grafts and CVCs to a minimum.
The use of a CVC should be limited to those who, due to comorbidities or the exhaustion of vessels usable for AVF, have no other option for undergoing haemodialysis replacement treatment.
The use of a CVC is also envisaged as a bridging access while awaiting AVF maturation, whether native or prosthetic, or in those patients in whom it is necessary to wait for the general or local clinical conditions that initially contraindicated the creation of a permanent implanted vascular access to be met.
Numerous studies have compared the clinical outcomes associated with different vascular access types.
The DOPPS study (Dialysis Outcomes and Practice Patterns Study) showed that in Europe (France, Germany, the United Kingdom, Italy, Spain) the highest prevalence of AVF use among haemodialysis patients is found in Italy. This finding was subsequently confirmed by the DOPPS III study.
Objectives
3
Results
The results obtained demonstrated that close monitoring and surveillance by a multidisciplinary team are able to increase dialysis adequacy and AVF longevity and to reduce patient mortality.
For this reason, their inclusion in the dialysis-care protocol can be considered a meaningful innovation in clinical practice that supports longer vascular access survival, greater dialysis efficiency and greater patient survival, with a higher quality of life.
