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February 12, 1997

Vascular Access in Patients Receiving Hemodialysis-Reply.

Author Affiliations

University of Michigan School of Public Health Ann Arbor

JAMA. 1997;277(6):456. doi:10.1001/jama.1997.03540300024015

In Reply.  —Dr Qureshi was surprised that the increased availability of the tunneled vascular catheter (Perm catheter, Quinton, Seattle, Wash) did not lead a greater proportion of patients, particularly late referred patients, to receive AVFs. We believe that this is indicative of a lack of resolve on the part of surgeons, nephrologists, or both to wait for the maturation of an AVF. We agree that the availability of improved temporary vascular access methods provides an excellent opportunity to attempt an AVF in patients who are referred late but who are otherwise suitable candidates.Dr Qureshi also wonders if case-mix differences between Japan and the United States account for the report of Bleyer et al1 that 100% of newly treated patients received AVFs in several Japanese dialysis units.1 Two factors suggest that the Japanese hemodialysis case mix is not as severely affected as the case mix in the United States. First,