The Cost of Putting Fistula First

The nephrology community has made great strides in increasing the proportion of patients who are using an arteriovenous fistula (AVF) for maintenance hemodialysis therapy. Observational studies that have examined associations between type of vascular access and clinical outcomes have generally reported lower rates of infection and mortality with AVFs when compared with either tunneled catheters or arteriovenous grafts (AVGs).1 These findings led to increased AVF creation, which was further spurred on by clinical guidelines and initiatives from the Centers for Medicare & Medicaid Services (CMS), such as the Fistula First Catheter Last program.

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