The following are some specific things nephrologists can do to begin to increase AV fistula use in dialysis patients. These are actions that you can take immediately; they will require cooperation between and, perhaps, changes in practice of, all providers in the system.

1. Know the rates of AV fistula prevalence and incidence for your patients.
2. Review the recommended strategies from the Fistula First Change Package and choose those that make the most sense for your practice. For example, consider the following changes:

• Change Concept 2 – Timely Referral to Nephrologist
• Change Concept 3 – Early Referral to surgeon for “AVF Only" Evaluation and Timely Placement
• Change Concept 4 – Surgeon Selection Based on Best Outcomes, Willingness, and Ability to Provide Access Services
• Change Concept 6 – Secondary AVF Placement in Patients with AV Grafts
• Change Concept 7 – AVF Placement in Patients with Catheters Where Indicated
• Change Concept 9 – Monitoring and Maintenance to Ensure Adequate Access Function
• Change Concept 10 – Education for Caregivers and Patients
• Change Concept 11 – Outcomes Feedback to Guide Practice