Journal Information
Vol. 43. Issue. S2.December 2023
Special Issue December
Pages 1-138
Vol. 43. Issue. S2.December 2023
Special Issue December
Pages 1-138
Letter to the Editor
Full text access
Public–private collaboration in the gestion of hemodialysis vascular access
Colaboración público-privada en la gestión del acceso vascular para hemodiálisis
María Isabel Martínez Marína, Cándido Díaz Rodriguezb, Alejandro Moro Mayorc, María Dolores Arenas Jiméneza,
Corresponding author

Corresponding author.
a Fundación Íñigo Álvarez de Toledo, Madrid, Spain
b Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
c Hospital Quirónsalud A Coruña, Coruña, Spain
This item has received
Article information
Full Text
Download PDF
Tables (1)
Table 1. Percentage of prevalent patients with CVC or nAVF/prosthesis at the end of the two study periods.
Special issue
This article is part of special issue:
Vol. 43. Issue S2

Special Issue December

More info
Full Text
Dear Editor,

The native arteriovenous fistula (nAVF) is the vascular access (VA) of choice for haemodialysis (HD) as opposed to central venous catheters (CVC).1,2 Outcomes can be influenced by organisational and resource management factors.3,4 The high use of CVC in units is a long-standing problem,5,6 worsened by the COVID-19 pandemic,7 during which elective surgeries, including VA,8 were postponed and the public health service failed to resolve the problems of delayed interventions in all specialist areas.9 The high proportion of CVC makes it necessary to devise strategies to reverse this situation. From July 2021 at the Lalín centre, attached to Hospital de Santiago, an agreement was established that stipulated that the centre was responsible for the creation of VA which did not require hospital admission for patients in its area, including patients with advanced chronic kidney disease (ACKD). The hospital took care of VA requiring hospital admission (prosthesis or basilic superficialisation)4,5; of patients who were dialysed at the centre from October 2020 to February 2022; 24 (53.3%) had CVC. Ten patients were assessed for nAVF at the external centre. Four patients were referred to the referral hospital; two because they required inpatient techniques and two refused the referral to the outpatient centre. Six autologous nAVF were performed at the external centre (two radiocephalic and four elbow nAVF), all of which were functional. The average time from mapping at the outpatient centre was 10.5 days and from mapping to surgery 11 days; at the hospital it was 73 days. The percentage of catheters decreased and the percentage of fistulae increased significantly in prevalent patients at the centre (Table 1). VA surgery does not require hospitalisation or general anaesthetic,10 so it can be performed at outpatient surgery centres outside hospital circuits, speeding up the intervention and not interfering with (or being interfered with by) more urgent or complex disorders. The strategy of combining resources and managing public and private capacities jointly from the referral hospital offers a valid and effective alternative to improve outcomes within a very short time, with the greatest safety.

Table 1.

Percentage of prevalent patients with CVC or nAVF/prosthesis at the end of the two study periods.

  Period 1: 1/October/2020 to 30/June/2021, before the start of the public–private partnership  Period 2: 1/July/2021 to 28/February/2022, after the start of the public–private partnership 
Central venous catheter  26 (55.6%)  12 (26.7%)  <0.001 
Native fistulae/prosthesis  20 (44.4%)  34 (73.3%)   

nAVF: native arteriovenous fistula.

C. Combe, J. Mann, D. Goldsmith, F. Dellanna, P. Zaoui, G. London, et al.
Potential life-years gained over a 5-year period by correcting DOPPS-identified modifiable practices in haemodialysis: results from the European MONITOR-CKD5 study.
BMC Nephrol, 20 (2019), pp. 81
A. Al-Balas, T. Lee, C.J. Young, J.A. Kepes, J. Barker-Finkel, M. Allon.
The clinical and economic effect of vascular access selection in patients initiating hemodialysis with a catheter.
J Am Soc Nephrol, 28 (2017), pp. 3679-3687
E. Gruss, J. Portolés, P. Jiménez, T. Hernández, J.A. Rueda, J. del Cerro, et al.
Seguimiento prospectivo del acceso vascular en hemodialisis mediante un equipo multidisciplinar.
Nefrologia, 26 (2006), pp. 703-710
E. Gruss, J. Portolés, P. Caro, J.L. Merino, P. López-Sánchez, A. Tato, et al.
Grupo de Estudio del Acceso Vascular (AVE). Los modelos de atención al acceso vascular condicionan resultados heterogéneos en los centros de una misma comunidad.
T. Malek, F. Alvarez-U de, M.T. Gil, A. Moledous, M. López-Collado, C. Núñez, et al.
Cambios en el acceso vascular en una unidad de diálisis en los últimos años: problemas de planificación, cambio de preferencias o cambio demográfico? [Changes in vascular access in a dialysis unit in recent years: planning problems, change in preferences, or demographic change?].
Nefrologia, 28 (2008), pp. 531-538
R.L. Pisoni, L. Zepel, F.K. Port, B.M. Robinson.
Trends in US vascular access use, patient preferences, and related practices: an update from the US DOPPS practice monitor with international comparisons.
Am J Kidney Dis, 65 (2015), pp. 905-915
M.D. Arenas Jimenez, A. Méndez, K. Furaz, A. Botella, D. Yetman, R. Cazar, et al.
Renal Foundation’s Iñigo Álvarez de Toledo work team. Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.
Clin Kidney J, 15 (2022), pp. 1340-1347
K. Søreide, J. Hallet, J.B. Matthews, A.A. Schnitzbauer, P.D. Line, P.B.S. Lai, et al.
Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services.
Br J Surg, 107 (2020), pp. 1250-1261
Copyright © 2022. Sociedad Española de Nefrología
Nefrología (English Edition)
Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?