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December 7, 2025
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Abstract

Introduction: Refusal of arteriovenous fistula represents a challenge in haemodialysis. Nursing intervention is decisive in shared decision-making.
Objective: To evaluate the impact of a structured multidisciplinary intervention aimed at addressing refusal of arteriovenous fistula creation in patients with chronic kidney disease.
Material and Method: Prospective multicentre pilot study divided into four groups according to their situation regarding vascular access. The intervention included visual education, team training in communication skills, and ultrasound. Demographic, clinical, and intervention variables were analysed. The study received ethical approval and informed consent was obtained. Analyses were performed using parametric tests (t-Student, ANOVA) and non-parametric tests (Mann–Whitney U, Kruskal–Wallis).
Results: A total of 51 patients were included, with a mean age of 67.4±13.4 years (68.6% men). After the intervention, 68.6% opted for arteriovenous fistula. Nursing led 100% of the initial consultations (mean 30±12.7 minutes). Acceptance was total in the ERCA group (100%) and high in incident patients (78%) vs 35% in prevalent patients with CVC>6 months (P<0.001). Subsequent multidisciplinary consultations significantly increased acceptance compared with nursing-only consultations (P<0.05). The main barriers were fear of surgery (54%) and catheter comfort (46%). Those who accepted fistula were younger (P<0.05).
Conclusions: Nursing positively leads decision-making through a structured and empathetic approach. The ERCA consultation is key for early planning, whereas in long-term catheter carriers, earlier interventions are required.

Keywords

vascular access arteriovenous fistula central venous catheter haemodialysis shared decision-making multidisciplinary intervention

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Copyright (c) 2026 Mª Luz Sánchez-Tocino, María Dolores Arenas-Jiménez, Julia Audije-Gil, Silvia Reyes-Bonilla, Aitana Hernández-Pérez, Ana Mª Sacristán-Román, Marta Moreda-Díaz-Pavón, Leonor Andúgar-Rocamora, José Luis Santos-Ascarza-Bacarizad, David Hernán-Gascueña, Florentina Rosique-López, Unidad de Investigación Fundación Renal Española

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Sánchez Tocino ML, Arenas Jiménez MD, Audije Gil J, Reyes Bonilla S, Hernández-Pérez A, Sacristán Román AM, et al. ERCAV project. Relevant role of nursing in decision-making on vascular access in renal patients. Results of the pilot study. Enferm Nefrol [Internet]. 2026 [cited 2026 Ma 6];29(1):[about 9 p.]. Available from: https://enfermerianefrologica.syspre.sysprovider.com/revista/article/view/4980
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Sánchez Tocino ML, Arenas Jiménez MD, Audije Gil J, Reyes Bonilla S, Hernández-Pérez A, Sacristán Román AM, et al. ERCAV project. Relevant role of nursing in decision-making on vascular access in renal patients. Results of the pilot study. Enferm Nefrol [Internet]. 2026 [cited 2026 Ma 6];29(1):[about 9 p.]. Available from: https://enfermerianefrologica.syspre.sysprovider.com/revista/article/view/4980
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