Complications associated with hemodialysis vascular access are among the most important causes of morbidity and expense in end stage renal disease (ESRD) hemodialysis patients in the United States today. The most frequent cause of graft failure is thrombosis usually due to venous stenosis. Based on results from nonrandomized studies using historical controls, the National Kidney Foundation - Dialysis Outcomes Quality Initiative (NKF-DOQI) have recommended a program of routine monitoring and prophylactic repair of graft stenosis prior to development of graft thrombosis. The DOQI guidelines are widely considered to be the standard of care for hemodialysis patients. A randomized, controlled study of this prophylactic approach has been conducted at our institution and demonstrates no increase in duration of graft life but, in fact, an increased risk of infection in those patients assigned to angiographic intervention. ? ? The proposed study addresses the generalizability of these findings using a large, national database, the United States Renal Data System (USRDS) to examine the association between hemodialysis access procedures (angiograms and angioplasties) and graft infections. We will perform a retrospective, case-control study to determine whether patients who develop a graft infection are more likely to have had a graft angioplasty than a control group without graft infection. The improvement of hemodialysis vascular outcomes is an area of intense interest in the nephrology community and the optimal procedures for monitoring and maintenance have yet to be rigorously tested. The results of the proposed study will have important clinical and economic implications.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
5F32DK062671-02
Application #
6650189
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Rankin, Tracy L
Project Start
2002-07-01
Project End
2004-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
2
Fiscal Year
2003
Total Cost
$56,308
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118