#1711 The impact of a multidisciplinary vascular access team on haemodialysis vascular access-related outcomes

Background and Aims Autologous arteriovenous fistulae (AVF) are considered the vascular access (VA) of choice for most haemodialysis (HD) patients. Timely AVF creation, adequate AVF maturation and assurance of long-term functional patency significantly benefit this population. International guidelines suggest the creation of multidisciplinary VA programs to improve access-related outcomes. This study aims to evaluate the results of the institution of a multidisciplinary VA team at our center. Method A retrospective case-control study was performed, comparing our center's incident HD patients from years 2019 and 2022. A multidisciplinary VA team was created in 2021. Patient data was collected from their electronic health record, namely demographic variables, comorbidities, prior nephrology (NA) and vascular access appointments (VAA), and access typology at the beginning of HD. The primary outcome was VA used for HD initiation. Secondary outcomes were time until multidisciplinary VAA, AVF creation and maturation, and the prevalence of AVF at six months for patients who initiated HD with a central venous catheter (CVC). Analysis of the results was performed using SPSS v28.0. A p-value < 0.05 was considered statistically significant. Results 184 and 169 incident HD patients were included from years 2019 and 2022, respectively. There were no significant differences regarding demographic variables, comorbidities and prior NA. 42.4% and 37.3% of patients had been observed in a VAA at least 6 months before HD initiation, in 2019 and 2022 respectively (p = 0.095). Significantly more patients started HD with an AVF in 2022 (37.5% vs 50.9%, p = 0.011), regardless of demographic variables, VAA and AVF creation prior to HD institution. For those who started HD with a CVC (62.5% in 2019 and 49.1% in 2022), the median time until VAA (33 vs 25.5 days, p = 0.045), AVF placement (87 vs 46 days, p < 0.001) and puncturable AVF (203 vs 132 days, p < 0.001) were significantly lower in 2022. At 180 days post-HD initiation with CVC, the number of puncturable AVFs was also significantly higher in 2022 (26.1% vs 38.6%, p = 0.002). Conclusion Multidisciplinary VA teams have a positive impact on the number of patients who start HD with AVF. For those who initiate HD using a CVC, these teams are also a major determinant in the number of functional AVFs.