Patient with family and doctorHealthcare professionals

Welcome to the Fistula First website. Here you will find information and resources for vascular access management for patients and healthcare professionals.


Over the last decade, remarkable improvements in arteriovenous fistula (AVF) use in prevalent hemodialysis patients were achieved through the Fistula First Breakthrough Initiative (FFBI) in partnership with:

  • the Centers for Medicare & Medicaid Services (CMS)
  • the End Stage Renal Disease (ESRD) Networks
  • Patients
  • the renal community
  • additional stakeholders

During its tenure the FFBI had as it central focus, increasing the percentage of AVF in use as the vascular access with the best outcomes showing an increase from 32% to >60%. Click here to review Fistula First data.  


The FFBI had less impact on reducing catheter use. Accordingly, in May of 2013, the ESRD Network Coordinating Center (NCC) launched the Fistula First Catheter Last (FFCL) Workgroup Coalition project, building on the foundation of the Change Concepts and success of the FFBI, but with an emphasis on decreasing the use of tunneled dialysis catheters (TDC) as long-term vascular accesses.  The FFCL Workgroup Coalition is comprised of patients, representatives from the CMS, ESRD Networks,  the renal community, and other stakeholders.


Research shows that AVFs have the longest survival, result in fewer access related procedures, fewer hospitalizations due to infection and lower overall costs of care.  The Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access clinical practice guidelines provided the evidence base and expert opinion of the targets and framework of the FFBI.  Quality improvement information was disseminated and implemented using the core clinical principles, the Fistula First Change Concepts.


Article: Targeting Catheters Last in Fistula First

Clinical Consultants

Joseph A. Vassalotti, MD, FASN
National Kidney Foundation 
New York, NY

David Fox, MD, FACS
Lennox Hill Hospital
New York, NY

Tushar Vachharanjani, MD
W.G. "Bill" Hefner Medical Center
Slaisbury, NC


Brian Koll, MD, FACP, FIDSA
Beth Israel Medical Center
New York, NY


CMS Representatives

Kathleen Egan, RN, MSN, CPHQ
Technical Advisor – ESRD Program Lead – GTL NCC

Boston, MA

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Updates Coming Soon 


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