Multidisciplinary clinics improve vascular access, outcomes in haemodialysis patients

Implementing multidisciplinary care among patients undergoing haemodialysis results in significant increases in the use of definitive vascular access and reductions in intensive care unit (ICU) admissions and recurrent hospitalizations, reports a Singapore study.

“The comprehensive and coordinated care provided by multidisciplinary clinics (MDC), including early intervention, continuous monitoring, patient education, and holistic support, addresses the complexities of haemodialysis management more effectively than conventional single-nephrologist care,” according to the researchers.

A total of 145 patients newly started on haemodialysis were included in this single-centre, retrospective cohort study and were assessed over a 12-month follow-up period. Definitive vascular access for haemodialysis was the primary outcome, while secondary outcomes included frequencies of catheter-related bloodstream infections, ICU admissions, and recurrent hospitalizations.

Definitive vascular access referred to the use of an arteriovenous fistula (AVF) or arteriovenous graft (AVG) for three or more haemodialysis sessions.

Of the patients analysed, 53 were in the MDC group and 92 in the conventional group. [Proc Singap Healthc 2025;doi:10.1177/20101058251314524]

Only 10 percent of patients started haemodialysis with definitive access, but those in the MDC group showed greater utilization of definitive vascular access after 6 months (odds ratio [OR], 2.44, 95 percent confidence interval [CI], 1.16–5.26; p=0.039). 

In addition, the MDC cohort had fewer ICU admissions (OR, 0.92, 95 percent CI, 0.87–0.97; p=0.026) and recurrent hospitalizations (OR, 0.13, 95 percent CI, 0.04–0.49; p=0.001). They also had fewer catheter-related infections than the conventional group (5.6 percent vs 14 percent), but the difference did not reach statistical significance (OR, 0.34, 95 percent CI, 0.47–18.46; p=0.709).

“The lower, albeit nonsignificant, rate of catheter-related bloodstream infections observed in the MDC group warrants further exploration,” the researchers said. “The lack of statistical significance may be primarily attributed to the small sample size, which likely limited the study’s power to detect meaningful differences.”

Continuous process

Previous studies have analysed the effects of multidisciplinary clinics on mortality and morbidity in patients undergoing haemodialysis, with a focus on either the initiation stage or postdialysis care. [Nephron 2015;129:263-268; Nephrol Dial Transplant 2017;32(suppl_2):ii91-ii98]

“However, haemodialysis management is a continuous process, covering from predialysis to postdialysis phases,” the researchers said. “This pilot study assessed the comprehensive care delivered by MDCs throughout the entire dialysis journey.” [Am J Kidney Dis 2017;69:8-10]

The MDC program was started 1 year prior to the initiation of haemodialysis in the low clearance clinic and continued through the transitional care clinic for up to 1 month after initiation. Patients who chose to undergo haemodialysis were monitored every 2–3 months before starting treatment and re-evaluated 1 month after initiation. The timely creation of definitive vascular access was the main focus.

"In the low clearance clinic, patients are offered an educational program by the National Kidney Foundation called the ‘Know Right Start Right’ program, which emphasizes the importance of establishing definitive dialysis access, such as AVF/AVG, for those opting for haemodialysis,” the researchers said. [https://nkfs.org/kidney-failure/pre-dialysis-education-programme-faqs/]

“This approach emphasized the importance of establishing functional vascular access before starting haemodialysis, ensuring a smooth and structured transition to dialysis,” they added.