Dialogues in Dialysis Access
The world of dialysis access intervention has not seen as many ground-breaking advancements as other specialty areas. However, as we look for ways to improve patency rates, reduce reinterventions, and enhance quality of life for dialysis patients, open dialogue—between physicians, patients, providers, and industry—is crucial. In this issue, our authors recount recent improvements, continued successes, and future developments across various aspects of dialysis access intervention. Sharing knowledge about the current landscape of dialysis access allows us to better understand the challenges and issues we face. By keeping the lines of communication open, we can continue to push advancements in dialysis access further.
Our discourse begins with an article by Charmaine E. Lok, MD, who summarizes some of the changes in hemodialysis access over the past decade and alludes to changes in the updated National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines on vascular access, expected to be released in 2018. Next, Prabir Roy-Chaudhury, MD, believes we are in the midst of a fundamental change in the way we look at health care in vascular access. With adoption of global payment systems, he foresees the potential for innovation, process of care improvements, and better metrics to measure quality of care.
We then glance into the future of arteriovenous (AV) fistula creation, asking several experts, “Where do you see percutaneous AV fistula creation fitting into practices in the next several years?” Sanford Altman, MD; Eric K. Peden, MD; Mark Turco, MD; and James F. McGuckin, Jr, MD, offer their outlook on the future of percutaneous AV fistula access creation and discuss its ability to meet an unmet need. Next, Peter B. Hathaway, MD, shares his 10 lessons learned in peritoneal dialysis, as well as his observations on improving quality of care and outcomes related to the use of peritoneal dialysis catheters and shares both technical and nontechnical tips.
Another area of interest is the use of drug-coated balloons in dialysis access intervention. In a second Ask the Experts panel, Scott Trerotola, MD; Kate Steiner, BSc, MBBS; Andrew Holden, MBChB; and Prabir Roy-Chaudhury, MD, discuss the impact of patency, cost-effectiveness, and reimbursement on drug-coated balloons if and when they are used. Finally, the future of dialysis access intervention also involves future dialysis access specialists. Ingemar Davidson, MD, examines the dialysis access education landscape and what it will take to train the next generation of specialists.
In addition to our feature coverage, Katharine L. Krol, MD, reviews the new 2017 CPT codes for dialysis access maintenance and intervention, including the new definitions and instructions for the code set, and illustrates the use of the codes in multiple scenarios.
We also interview Isabel Newton, MD, and Susan Jackson, MBA, founders of the Interventional Initiative, who discuss the importance of bringing minimally invasive, image-guided procedures to the forefront of the health care system and outline the goal and challenges of their organization. Finally, in our featured interview, Wei Zhou, MD, shares her insight into various vascular topics, including the use of a brain structural connectivity graph for treatment selection and the impact of embolic infarct volume on cognitive changes.
Success in dialysis access is vital for our patients’ well-being. We must build upon our current knowledge to reach future advancements—and keep the conversations going!
Bart Dolmatch, MD, FSIR
Guest Chief Medical Editor