Interventional nephrology is in the midst of an exponential growth phase, with data from the U.S. Renal Data System suggesting that at least 25 percent of total vascular access procedure costs are billed by nephrologists (1). Indeed, it is likely that the growth of interventional nephrology as a distinct discipline within nephrology has played an important role in the success of process-of-care initiatives, such as Fistula First, which has raised the arteriovenous fistula (AVF) prevalence rate from 34 percent in December 2003 at the start of this initiative to 59.5 percent as of August 2011 (2).
The Kidney Health Initiative (KHI) was created in September 2012 through the signing of a memorandum of understanding between the American Society of Nephrology and the U.S. Food and Drug Administration. It is important to give recognition here to Dr. Ronald J. Falk, who in his role as ASN President at the time, was the true visionary and champion behind the formation of KHI (together with strong support from FDA leadership).
The rationale behind the formation of KHI was simple. Despite the very significant morbidity, mortality, and economic cost associated with diseases of the kidney, there were almost no new
Hemodialysis vascular access is without question the lifeline for the more than 400,000 patients undergoing hemodialysis in the United States. Unfortunately, because of the high incidence of dialysis vascular access dysfunction, it is also the “Achilles heel” of hemodialysis (1, 2). There are currently three main forms of permanent dialysis vascular access, each of which have their pros and cons.
Arteriovenous fistulae (AVFs) are the preferred form of permanent dialysis vascular access because of their prolonged long-term survival and lack of infection. Indeed, the Fistula First initiative has increased the current AVF