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Patients at the core of research into vascular access

30 April 2024

What is vascular access?

Almost 30,000 people in the UK receive haemodialysis - a procedure that helps to remove waste and excess fluids from the blood when the kidneys are not working properly. A key part of this procedure is how the patient’s bloodstream is connected to the dialysis machine, and this is a term referred to as ‘vascular access’. 

The two most common types of vascular access for haemodialysis are: 

  • Arteriovenous fistula (AVF): a special connection that is made by joining a vein onto an artery, typically in the arm, to create a large sturdy vessel that can be regularly accessed with needles for haemodialysis. This is the traditional approach that is currently used first in most patients.
  • Arteriovenous graft (AVG): a connection is made between an artery and a vein using a piece of soft tubing. These are usually used when a patient’s blood vessels are not suitable for fistula formation, or if attempts to create a fistula have been unsuccessful.

Why is vascular access important?

A good vascular access is essential for haemodialysis to work well and is one of the most important, yet challenging, aspects of kidney care. We are currently supporting StAFF PAVia, two innovative trials which will firstly look to establish whether some patients might benefit from receiving an AVG as their first method of vascular access (StAFF), and then to establish the best way to treat venous stenosis - narrowing of a vein that can occur as a complication associated with AVG (PAVia).  

Working with patients to improve vascular access

Involving patients in research and the design of studies ensures that studies are meaningful, relevant to patient experiences, and focus on the outcomes that benefit patients the most. At Kidney Research UK, people living with and at risk of kidney disease are at the heart of everything we do, and the importance of collaboration between patients and researchers is becoming more widely recognised and adopted across the kidney research field. 

The Vascular Access Society of Britain and Ireland (VASBI) is a multi-disciplinary society in the UK dedicated to improving the care and quality of life of haemodialysis patients. The society have an annual meeting, where dedicated professionals come together to share knowledge and experience in the vascular access field.

We caught up with VASBI president Dr Rob Jones from Queen Elizabeth Hospital Birmingham, and Professor David Kingsmore, chief investigator on the StAFF PAVia studies from the University of Glasgow to discuss the impact of including patients in the last VASBI annual meeting. 

Could you tell us a little about what VASBI is, and the purpose of your annual meeting? Why is it important to have these multidisciplinary meetings? 

Rob: VASBI is the only multi-disciplinary society in the UK dedicated to vascular access and it involves all professionals who take part in vascular access care– nephrology, interventional radiology, surgery – transplant and vascular surgery, sonography and specialist nurses. While each different specialist may have focus on their own part in providing and maintaining vascular access, ultimately, a patient just wants to be able to use their access to provide good dialysis. This requires everyone to work together in a complimentary fashion. The annual meeting is for everyone who has an interest in this area. Within the meeting programme, we try to include every aspect of vascular access, from new research, to better ways of working, and most importantly taking onboard what patients think. The meeting is truly multi-disciplinary and provides an excellent forum for learning and discussion.  

The president of VABI Dr Rob Jones
Dr Rob Jones, VASBI president
Professor Kingsmore who is the chief investigator on the study.
Professor David Kingsmore

Why is it so important to involve patients when planning future research? 

David: The vascular access of each patient is at the end of a very complicated process – to work out what works best, how to create this, how to maintain it and how to use it best.

Ultimately, few of us have been in the position of patients and have only our observations to help in making the care and support we provide as good as possible. There are many limits to this, and getting a patient’s perspective on what we are doing and how we go about it can help to ensure that this remains at the centre of our research and services.  

How did you involve patients in this year’s meeting? What did you learn from including patients and how are you planning to continue this in future meetings? 

Rob: This year was unusual – we really tried to get a better insight into what patients experience, and how we can use this information to better guide our management of vascular access. We were helped by a few haemodialysis patients who attended the meeting, and it was encouraging to see them getting involved in discussions.

We also had a ‘Question Time’ session that was focused on the patient perspective and even had a psychologist on the panel. Ultimately, I think everyone gained a lot from this approach - it helped to provide further insight and made us think of vascular access from an additional perspective. Hopefully this will continue and grow at future meetings.  

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