Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
New York, NY (June 14, 2010) — Dr. Timmy Lee, Assistant Professor of Clinical Medicine, Division of Nephrology and Hypertension at the University of Cincinnati, was awarded the third Franklin McDonald, MD, Fresenius Medical Care Clinical Research Young Investigator Award, the National Kidney Foundation announced today. He received a three-year grant to support his project, entitled "Evaluating Processes of Care to Increase Arteriovenous Fistula (AVF) Incidence."
According to NKF, an AVF is the preferred method of dialysis access since its long term outcomes have been proven better than catheters and grafts. Dialysis patients who use AVFs have fewer infections and hospitalizations and a lower mortality rate.
"The initial goal of NKF's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines on vascular access was to have 40% of those currently on dialysis using AVF. With the dissemination of the KDOQI guidelines and the implementation of the government's Fistula First Initiative, that goal has been exceeded. About 50% of those currently on dialysis use AVFs. Both KDOQI and the Fistula First Initiative have now revised their goals to 65% for AVF utilization in people currently on hemodialysis. However, only about 15% of those initiating dialysis begin with an AVF and that's the group I will be focusing on," says Dr. Lee.
Dr. Lee's research project will investigate ways to increase AVF use in those starting dialysis for the first time. "Barriers to beginning dialysis with AVF include the necessity of early referral from an internist to a nephrologist. If dialysis is needed on an emergency basis, the patient would have to start with a catheter. If advance planning is done, there is time for an AVF to grow. In order to use an AVF, patients must be referred by their nephrologist for vein mapping so the surgeon knows in which vessels they can insert the access. Once surgery is performed, the growth of the access must be monitored closely. So the entire process can take anywhere from three to six months," says Dr. Lee.
Dr. Lee's research is an observational study, to be conducted in a new multidisciplinary Veterans Administration (VA) clinic in Cincinnati, that will focus on patients with stage 4 and 5 chronic kidney disease who are not yet on dialysis. Surgeons, dietitians, nurse practitioners, and nephrologists will work to improve AVF use and data will be compared to a historical control group. The research project will analyze at what level of kidney function, or GFR, nephrologists begin planning and discussing dialysis modality selection and at what GFR level the vessel mapping and surgery is being performed. The goal is to learn what impact early referral and a dedicated focus on vascular access care in patients with advanced chronic kidney disease has on the rate of incident AVF use.
"If the data we collect from this observational study shows that the clinic is significantly improving AVF use because of earlier vessel mapping and surgery, then we will try to replicate these results within VA systems nationwide through KDOQI and Fistula First. We will recommend the widespread establishment of these multidisciplinary clinics," says Dr. Lee.
"The Franklin McDonald, MD, Fresenius Medical Care Clinical Research Young Investigator Award is designed to stimulate clinical research which could ultimately result in improved care for patients with end-stage renal disease," says Dolph Chianchiano, Senior VP for Research, Scientific and Public Policy. "We are pleased to fund Dr. Lee's promising research through this award, which was named in memory of Dr. Franklin D. McDonald, a nephrologist who dedicated more than 20 years of volunteer activity to the patient service goals of the NKF."
The Franklin D. McDonald Fresenius Medical Care Clinical Research Young Investigator Award was made possible by the generosity of Fresenius Medical Care North America.
Dr. Lee is a member of the Cincinnati Dialysis Access Program, which is a translational research program, based at the University of Cincinnati, focused on improving dialysis access outcomes. He is also a staff nephrologist at the Cincinnati Veterans Administration Medical Center.
The National Kidney Foundation is dedicated to preventing and treating kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases and increasing availability of all organs for transplantation.
For more information on NKF's research program visit www.kidney.org/professionals/research