TITLE: Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients.

BACKGROUND:Patients who commence haemodialysis (HD) through arteriovenous fistulae and grafts (AVF/G) have improved survival compared to those who do so by venous lines.

OBJECTIVES:This systematic review aims to assimilate the evidence for any strategy which increases the proportion of HD patients starting dialysis through AVF/G.

DATA SOURCES:Medline, Embase, Cochrane Central and Scopus.

STUDY ELIGIBILITY, PARTICIPANTS AND INTERVENTIONS:English language studies comparing any educational, clinical or service organisation intervention for adult patients with end stage renal failure and reporting incident AVF/G use.STUDY APPRAISAL AND

SYNTHESIS:Two reviewers assessed studies for eligibility independently. Outcome data was extracted and reported as relative risk. Reporting was performed with reference to the PRISMA statement.

RESULTS:Of 1272 studies, 6 were eligible for inclusion. Studies varied in design and intervention. Formal meta-analysis was not appropriate. One randomised controlled trial and two cohort studies assessed the role of a renal access coordinator. Two cohort studies assessed the implementation of qualitive initiative programmes and one cohort study assessed a national, structured education programme. Results between studies were contradictory with some reporting improvements in incident AVF/G use and some no significant difference. Quality was generally low.

CONCLUSIONS:It is not possible to reach firm conclusions nor make strategic recommendations. A comprehensive package of care which educates and identifies patients approaching dialysis in a timely manner may improve incident AVF/G use. An unbiased, robust comparison of different strategies for timing AVF/G referral is required.

SOURCE: De Siqueira J, Jones A, Waduud M, et al. Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients[J]. J Vasc Access, 2021:11297298211006994. DOI: 10.1177/11297298211006994.

背景：与静脉导管相比，通过动静脉内瘘和移植物（AVF / G）开始血液透析（HD）的患者具有更高的生存率。

目的：本系统综述旨在吸收任何可增加通过AVF / G开始透析的HD患者比例的策略的证据。

资料来源：Medline，Embase，Cochrane Central和Scopus。

研究资格，参与者和干预措施：英语研究比较了任何教育，临床或服务机构对成年晚期肾衰竭患者的干预措施，并报告了使用AVF / G的事件。

研究评估和概述：两名评价员独立评估研究。提取结果数据并报告为相对风险。报告是参照PRISMA声明进行的。

结果：在1272项研究中，有6项符合纳入条件。设计和干预方面的研究各不相同。正式荟萃分析是不合适的。一项随机对照试验和两项队列研究评估了肾脏通路协调员的作用。两项队列研究评估了定性倡议计划的执行情况，一项队列研究评估了一项国家结构性教育计划。研究之间的结果是矛盾的，有些报告说AVF / G的使用有所改善，而有些则没有显着差异。质量普遍较低。

结论：不可能得出明确的结论或提出战略建议。全面的一揽子护理可以及时教育和识别即将进行透析的患者，可以加强AVF / G的使用。但仍需要对用于AVF / G推荐时间的不同策略进行无偏见，可靠的比较。

启发：目前的研究只能说明一些趋势，但仍无法给出确切的建议，有待进一步研究。