Yim S, McElligot R, Powell S, Mitchell GL, Nahman NS Jr
Role of routine back-up vascular access (BUVA) in patients
receiving CAPD
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1435 1996
If a nephrologist has the time to prepare a patient to make an intelligent
choice of modalities, and the patient chooses peritoneal dialysis, should
the patient also be prepared with a vascular access as a "back-up?"
The authors compare the experience of 230 CAPD patients over 7 years 113
with and 117 without BUVA. Only 37% of the patients with BUVA and 25%
without BUVA required hemodialysis. The cost of temporary access for those
without BUVA was estimated at $7500. The cost of BUVA was estimated at
$252000 for those requiring HD and $426000 for those not requiring HD. The
authors argue that using temporary access for those CAPD patients who need
HD would save $657900, or about $3000/patient. (They assume each permanent
access costs $6000 and each temporary access costs $300)
Comment: It is not clear whether this abstract reports a change in
policy and a
review of that policy or a "study" to answer the question. In any case,
the reported cost savings are impressive and make sense in the coming era
of total capitation.
(Peter B. DeOreo MD, Case Western Reserve University, Cleveland)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula
Basic peritoneal dialysis :
PD catheters