From winter 2002 to summer 2005, the Centers for Medicare & Medicaid Services (CMS) engaged IHI to support the End Stage Renal Disease (ESRD) Networks in an initiative to increase rates of arteriovenous (AV) fistula placement and use for dialysis patients in the US. The work of the ESRD Networks and their partners (dialysis facilities, surgeons, nephrologists, interventional radiologists, nurses, and many others) has led to substantial increases in US AV fistula rates which translates into saved lives, improved quality of life for dialysis patients, and reduced costs for Medicare.

CMS and the ESRD Networks are continuing this groundbreaking work of spreading known best practices as part of the Fistula First National Vascular Access Improvement Initiative.

Fistula First has developed its own website to support this community. Please visit www.fistulafirst.org to find the content formerly available on IHI.org, as well as contact information for participation in this work.

IHI applauds the work of these dedicated providers.

According to United States Renal Data System (USRDS) 2003 Annual Data Report, approximately 400,000 end stage renal disease (ESRD) patients were in treatment in 2001. Just under 100,000 of those patients were new to the Medicare ESRD program that year. ESRD program payments in 2001 were approximately 6.4 percent of the 15.4 billion dollars in Medicare spending. Treatment options include hemodialysis, peritoneal dialysis, and transplantation. The majority of ESRD patients are treated in dialysis facilities.

The native arteriovenous (AV) fistula is the preferred type of vascular access for patients with end stage renal disease. Compared to catheters and AV grafts, native AV fistulae result in significantly lower rates of complication (such as infection and clotting), longer patency, fewer hospitalizations, lower patient morbidity, and significantly lower costs.

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Related Information on IHI.org:

Boosting Arteriovenous (AV) Fistula Rates in ESRD Patients

Renal Disease Management Across the Continuum

ESRD Network Program Where Ingrained Habits Are Giving Way to Best Practice