Healthcare Tips

AAKP Asks Congress to Promote Use of AV Fistulas for Vascular Access in Dialysis Treatment

April 24, 2020

In a letter addressed to key members of Congress (copy below), the American Association of Kidney Patients (AAKP) called upon Congress to include in upcoming Medicare legislation a provision to improve dialysis care for the nation's 400,000 kidney patients. Specifically, AAKP proposed that Congress give the Medicare program more authority to financially reward use of "AV fistulas" as the means to access the human body during dialysis treatment. AAKP President Brenda Dyson stated, "AV fistulas are the 'gold standard' of vascular access for dialysis patients. Dialysis patients with AV fistulas are simply healthier."

Dyson continued, "Medicare today pays for the care of most of the nation's 400,000 dialysis patients - but today's payment systems don't recognize the quality advantage of AV fistulas. Our proposal is good medicine for kidney patients - and would save the Federal government money!"

The following letter was sent to Senate Finance Committee Chairman Chuck Grassley (R-IA); Finance Ranking Member Max Baucus (D-MT); House Ways & Means Chairman Bill Thomas (R-CA) and Ranking Member Charles Rangel (D-NY); House Ways & Means Health Subcommittee Chair Nancy Johnson (R-CT) and Ranking Member Pete Stark (D-CA); House Energy & Commerce Chairman Joe Barton (R-TX) and Ranking Member John Dingell (D-MI); and House Energy & Commerce Health Subcommittee Chairman Nathan Deal (R-GA) and Ranking Member Sherrod Brown (D-OH):


August 24, 2005

On behalf of the American Association of Kidney Patients (AAKP), I am writing to ask you to include a savings provision worth nearly $1 billion (over 5 years) in the upcoming reconciliation legislation - which we believe is good medicine for America's dialysis patients. That provision would give the Centers for Medicare and Medicaid Services (CMS) more authority to encourage use of "AV fistulas" as the means to exchange blood in and out of the human body during dialysis treatment.

Here's the rationale and specifics of our proposal:

Dialysis treatment is an essential lifesaving procedure for 400,000 Americans whose kidneys no longer function. Dialysis involves removing blood from the body, passing the blood though a filter to remove waste products, and then returning the blood to the patient. The typical dialysis patient receives three dialysis treatments per week, which each take three or four hours per treatment.

There are several types of "vascular access" available to dialysis patients - or the means by which blood is removed and returned to the human body during dialysis. Types of vascular access include AV fistulas, catheters and grafts. A brochure that discusses these vascular access options is available on the AAKP Web site at aakp/AAKP/accessoptions.htm.

CMS actuaries reportedly estimate increasing use of AV fistulas for dialysis vascular access from current 30 percent to just 50 percent would save the Medicare program about $800M over 5 years (net of any new financial incentives). CMS apparently developed a legislative proposal to promote AV fistulas for the Medicare Modernization Act (MMA), but was not included in the final bill because the proposal was late to conference.

An AV fistula is the gold standard of vascular access for dialysis patients. As noted above, in the U.S., perhaps 25 percent to 30 percent of patients have AV fistulas; most have catheters or grafts. In Europe, those numbers are reversed.

Patients with AV fistulas live longer (e.g., because patients get fewer infections) and are less costly to Medicare (e.g., a well-done AV fistula is good for 25 years; catheters have to be replaced much more frequently). CMS TODAY PAYS MORE FOR LOWER QUALITY CARE.

CMS currently has a "Fistula First" initiative (one of CMS's breakthrough quality initiatives). This proposal would give CMS more explicit authority to execute that initiative. Fistula First is widely supported by the kidney community; see the list of supporters at fistulafirst/partners.htm.

Attached is a recent editorial from a medical journal, entitled "Fistula culture and no-excuses nephrology" - which criticizes the low use of AV fistulas in the U.S., and describes the value of broader use of AV fistulas.

Legislative text would simply provide the HHS Secretary with authority to provide physicians and dialysis clinics with bonus payments for successful placement, management, and maintenance of AV fistulas.

We appreciate your attention to this proposal. For further information, please contact Alexander Vachon, AAKP's Washington representative, at 202-667-1193, or Kris Robinson, AAKP's Executive Director/CEO, at 800-749-2257.

Thank you.


Brenda Dyson
American Association of Kidney Patients

AAKP is the voluntary, patient organization, which for more than 35 years, has been dedicated to improving the lives of fellow kidney patients and their families by helping them deal with the physical, emotional and social impact of kidney disease. The programs offered by AAKP inform and inspire patients and their families to better understand their condition, adjust more readily to their circumstances and assume more normal, productive lives in their communities.