Vascular Access Management: Going Beyond Current Practice - BCR PWR (June 2024)

Dr. Rupert Major, Dr. Mohammad Atiquzzaman, Dr. Merecedeh Kiaii, and Dr. Megan Borkum present their talk, “Vascular Access Management: Going Beyond the Current Practice,” as part of BC Renal’s and UBC’s province-wide rounds.
0:08:00 - Fistula Creation in BC Kidney Patients
Dr. Kiaii begins by describing how her team wanted to look at the portion of fistulas in BC that were being used soon after being created. She provides stats on vascular access creation in BC as part of her team’s study. She provides an overview of current referral process for AVF creation timing.
0:12:00 - KFRE helps vascular access timing
Dr. Atiquzzaman describes how his team conducted a retrospective cohort study to explore use of the Kidney Failure Risk Equation (KFRE) for vascular access timing. The results show that using the KFRE can increase the number of people who needed a vascular access point created and got one in a timely manner, and reduce the number of people who get one unnecessarily.
0:29:00 - Vascular access timing in the UK
Dr. Major then talks about demographics in the UK, noting a high southeast Asian population that is relatively more likely to being diagnosed with chronic kidney disease (CKD) at younger ages and later stages of disease. To accommodate these factors, Dr Major helped recalibrate the KFRE in the UK. He then explored how the recalibrated KFRE could help vascular access timing in the UK population. The results were similar to the BC study, where referrals were improved, but Dr. Major emphasizes that clinical judgement should be continued as well.
0:31:00 - KFRE threshold for vascular access timing
Dr. Atiquzzaman provides an overview of their next study, to find the ideal KFRE threshold for AVF creation.
0:40:00 - AVF care post-transplant
Dr. Kiaii discusses the pros and cons of creating fistulas, including a case study of a man who had both a transplant and a fistula.
Dr. Borkum provides background information on how AVF creation can have adverse cardiac effects, but notes there is no perfect vascular access option. She compares advantages of echocardiogram versus cardias MRI. She provides an overview of a proposed study to monitored patients with a fistula pre- and post-transplantation using cardiac MRIs, to see if they have adverse cardiac changes.
0:58:00 - Summary and Q&A
Dr. Kiaii provides a summary of the talk, before the doctors take questions from the audience.
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