Patient Perspectives on Arteriovenous Fistula Placement, Maturation, and Use: A Qualitative Study

Abstract

Rationale & Objective

Arteriovenous fistula (AVF) use among US hemodialysis (HD) patients is suboptimal, especially among Black patients. We interviewed a group of predominantly Black HD patients to probe experiences and perspectives surrounding steps along the AVF care continuum, which includes placement, maturation, and use of AVFs.

Study Design

Individual semistructured interviews.

Setting & Participants

Patients with kidney failure receiving HD in Birmingham, Alabama.

Analytical Approach

Transcripts were coded and thematically analyzed.

Results

We interviewed 53 Black and 6 White patients at different steps of the AVF care continuum: 29 were dialyzing with a central venous catheter (15 had not undergone AVF placement, 9 had a maturing AVF, and 5 had a nonfunctional AVF) and 30 were dialyzing with an AVF. We coded transcripts using qualitative thematic analysis. Three themes emerged: (1) the circumstances of dialysis initiation sometimes altered the timeline of AV access placement; (2) patients had variable levels of knowledge of steps along the AVF continuum; and (3) the life impacts of dialysis access were a significant factor in patients’ experience of dialysis.

Limitations

Single-institution study; low number of non-Black participants limited comparison of patient experiences by race.

Conclusions

Among a group of predominantly Black HD patients, perspectives surrounding the AVF care continuum included consideration of the circumstances of dialysis initiation, patient knowledge, and the life impacts of dialysis access. These findings may inform targeted interventions aimed at optimizing dialysis access use and addressing disparities across the AVF continuum.

Plain-Language Summary

People with kidney failure receiving hemodialysis (HD) rely on vascular access to undergo HD treatments. Though arteriovenous fistulas (AVFs) are preferred over tunneled dialysis catheters, AVF use is suboptimal especially among Black people with kidney failure. We interviewed 59 predominantly Black people with kidney failure who were at various stages of having an AVF placed. We aimed to understand their perspectives and experiences surrounding AVF placement, maintenance, and use. We learned that the circumstances of dialysis initiation, patient knowledge, and perceived life impacts of dialysis access contributed to perspectives on AVFs. These findings can help guide interventions that may address disparities in use of AVFs and optimize patient experiences around dialysis access.