Timmy Lee, MD, MSPH, is Associate Professor of Medicine in the Division of Nephrology and Staff Nephrologist at the Birmingham Veterans Affairs Medical Center. He is the Associate Director of Interventional Nephrology, Director of Hemodialysis at the Birmingham Veterans Affairs Medical Center, and Associate Fellowship Director of UAB Nephrology Fellowship Program. He also currently serves as a Councilor for the American Society of Diagnostic and Interventional Nephrology.

Dr. Lee received his medical degree from the Louisiana State University Health Sciences Center in Shreveport in 2001. Upon graduation he completed an internship and residency in internal medicine at the University of Alabama at Birmingham from 2001-2004. He then completed a clinical and research fellowship in nephrology at the University of Alabama at Birmingham in 2007. During his nephrology fellowship, he obtained a Masters of Science in Public Health in Epidemiology at the University of Alabama School of Public Health.

Dr. Lee’s research program has been funded by the National Institutes of Health, American Society of Nephrology Carl W. Gottschalk Award, and the University of Alabama at Birmingham Nephrology Research Training Center Anderson Innovation Award.

Research Interests:

Dr. Lee’s primary research focuses on hemodialysis vascular access dysfunction. He has both clinical and translational research programs in this area. Dr. Lee’s clinical research program within vascular access focuses on large population epidemiologic studies and clinical trials. His translational research program within vascular access focuses on understanding the pathophysiology of vascular access stenosis from human clinical studies and rodent AVF models. The long-term goals of Dr. Lee’s research program are to: (1) elucidate the mechanisms of why arteriovenous fistulas (AVF) fail to mature for dialysis (AVF non-maturation), (2) develop and test novel therapies to improve AVF non-maturation, and (3) improve the delivery of care and health outcomes for hemodialysis patients requiring a new dialysis vascular access.

Abstract:

Uniform vascular access guidelines for elderly patients may be inappropriate because of the competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes in this population. However, the outcomes in elderly patients with advanced CKD who receive permanent vascular access before dialysis initiation are unclear.

We identified a large nationally representative cohort of 3418 elderly patients (aged>70 years) with CKD undergoing predialysis AVF or arteriovenous graft (AVG) creation from 2004 to 2009, and assessed the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. In all, 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race.

Only one half of patients initiated dialysis with a functioning AVF or AVG; 46.8% of AVFs were created, 90 days before dialysis initiation. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF than in patients receiving AVG. In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 2 years.

As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter. Insertion of an AVG closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD.

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