Has the Fistula First Breakthrough Initiative Caused an Increase in Catheter Prevalence?

The use of central venous hemodialysis catheters (CVC) continues to be high among the incident as well as the prevalent HD patients. Whereas many strategies have been implemented to decrease the use of CVCs, their placement rates have doubled since 1996. While many factors, including late referral, are responsible for the increased use of CVCs, the arteriovenous Fistula First Breakthrough Initiative (known as "Fistula First" [FF]) has also been implicated in the increased use of CVCs. It has been suggested that while the FF initiative has resulted in a substantial increase in arteriovenous fistulae placement and use, it has also resulted in an increase in the use of CVCs. This report argues that catheter rates have remained unchanged and provides data regarding the impact of the FF initiative on catheter use.