The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis

Abstract

Background: Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. Method: Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. Results: In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients ( p = 0.08), while the cost of group C is significantly lower ( p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not ( p = 0.01, p = 0.02, respectively) during the first year of HD. Conclusion: With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients’ clinical journey and healthcare cost.

Effectiveness of a native vein arteriovenous fistula tracking system

“…Delayed or failed AVF maturation increases the CVC dependence days and also the risk of central vein stenosis in longer term 7,13 . In addition, patients with failed AVF creation underwent significantly more CVC exchange/reinsertion and incurred higher economic burden 14 . Prior studies reported various methods to promote AVF maturation including far‐infrared energy, 15 intra‐operative flow measurement, 16 intermittent compression therapy during early post‐operative period, 17,18 and ultrasound‐guided cannulation for early phase matured AVFs 19,20 .…”

“…7,13 In addition, patients with failed AVF creation underwent significantly more CVC exchange/reinsertion and incurred higher economic burden. 14 Prior studies reported various methods to promote AVF maturation including far-infrared energy, 15 intra-operative flow measurement, 16…”