Trends in Incident Hemodialysis Access and Mortality

Malas, Mahmoud B.; Canner, Joseph K.; Hicks, Caitlin W.; Arhuidese, Isibor; Zarkowsky, Devin S.; Qazi, Umair; Schneider, Eric B.; Black, James H.; Segev, Dorry L.; Freischlag, Julie A.

doi:10.1001/jamasurg.2014.3484

Cited by 166 publications

(86 citation statements)

References 33 publications

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“…Gillespie et al [16] found that pre-ESRD nephrology care for >12 months was significantly associated with initial AVF or graft use vs. catheter (aOR 11.3). Further, Chan et al [3] observed a 61% reduction in early death risk in those patients who initiated dialysis with an AVF, consistent with many studies demonstrating lower morbidity and mortality associated with AVF vs. catheter use [18,19,20,21,22,23,24,25,38,39]. In our study, the likelihood of catheter use at dialysis initiation was reduced by 67% among MHS vs. non-MHS patients, which could partly explain the improved survival in the MHS cohort, given the attenuation of its survival advantage after adjusting for vascular access types in the regression model.…”

Section: Discussionmentioning

confidence: 57%

“…One of the primary focuses of pre-ESRD care is the creation of an arteriovenous fistula (AVF), as recommended by the Kidney Disease Improving Global Outcomes to be the vascular access of choice for patients needing maintenance HD [17] due to its longevity and lower rates of infection and intervention. Many studies demonstrate that HD using an AVF is associated with improved survival and fewer hospitalizations compared with the complication-prone dialysis catheters [18,19,20,21,22,23,24,25]. …”

Section: Introductionmentioning

confidence: 99%

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Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Nee¹,

Fisher²,

Yuan³

et al. 2017

Am J Nephrol

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Background: Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. Methods: In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. Results: MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. Conclusions: MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Nee¹,

Fisher²,

Yuan³

et al. 2017

Am J Nephrol

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“…Ideally, swift transitions from use of a TCVC to an AVA would occur, such that chronic TCVC use (>3 months in the absence of a maturing AVA) would occur in <10% of prevalent patients [5]. Due to the frequent absence of pre-dialysis access preparation, advanced comorbidities, patient preference, acute illnesses, and other factors, this is an unmet goal; more than 60% of incident ESKD patients on HD continue to use a TCVC for more than 90 days [6]. For those who switch from using a TCVC to using an AVA, the dynamics of vascular access conversion extend beyond a one-time transition phase and few longitudinal studies assessed the aspects of interchanging accesses and sequence of AVA placement.…”

Section: Introductionmentioning

confidence: 99%

Vascular Access Placement Order and Outcomes in Hemodialysis Patients: A Longitudinal Study

Murea

Brown²,

Divers³

et al. 2017

Am J Nephrol

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Background: Arteriovenous accesses (AVA) in patients performing hemodialysis (HD) are labeled “permanent” for AV fistulas (AVF) or grafts (AVG) and “temporary” for tunneled central venous catheters (TCVC). Durability and outcomes of permanent vascular accesses based on the sequence in which they were placed or used receives little attention. This study analyzed longitudinal transitions between TCVC-based and AVA-based HD outcomes according to the order of placement. Methods: All 391 patients initiating chronic HD via a TCVC between 2012 and 2013 at 12 outpatient academic dialysis units were included in this study. Chronological distributions of HD vascular accesses were recorded over a mean (SD) of 2.8 (0.9) years and sequentially grouped into periods for TCVC-delivered and AVA-delivered (AVF or AVG) HD. Primary AVA failure and cumulative access survival were evaluated based on access placement sequence and type, adjusting for age. Results: In total, 92.3% (361/391) of patients underwent 497 AVA placement surgeries. Analyzing the initial 3 surgeries, primary AVF failure rates increased with each successive fistula placement (p = 0.008). Among the 82.9% (324/391) of TCVC patients successfully converted to an AVA, 30.9% returned to a TCVC, followed by a 58.0% conversion rate to another AVA. Annual per-patient vascular access transition rates were 2.02 (0.09) HD periods using a TCVC and 0.54 (0.03) HD periods using an AVA. Comparing the first AVA used with the second, cumulative access survivals were 701.0 (370.0) vs. 426.5 (275.0) days, respectively. Excluding those never converting to an AVF or AVG, 169 (52.2%) subsequently converted from a TCVC to a permanent access and received HD via AVA for ≥80% of treatments. Conclusions: HD vascular access outcomes differ based on the sequence of placement. In spite of frequent AVA placements, only half of patients effectively achieved a “permanent” vascular access and used an AVA for the majority of HD treatments.

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“…2 Moreover a higher proportion of patients initiate haemodialysis with a central venous catheter (CVC) in the USA (82.6%) than in any other country for which data are available. 3 Using a database of >500,000 US patients who initiated haemo dialysis between 2006 and 2010, Malas et al analy sed the trends in incident vascular access use and the impact of type of incident vascular access on patient survival. 3 They identified a marginal increase in the use of AVFs for incident vascular access from 12.2% in 2006 to 15.0% in 2010; CVC use remained consistently high (82.5%) during the study period.…”

mentioning

confidence: 99%

“…3 Using a database of >500,000 US patients who initiated haemo dialysis between 2006 and 2010, Malas et al analy sed the trends in incident vascular access use and the impact of type of incident vascular access on patient survival. 3 They identified a marginal increase in the use of AVFs for incident vascular access from 12.2% in 2006 to 15.0% in 2010; CVC use remained consistently high (82.5%) during the study period. Importantly, adjusted mortality was 35% lower in those using an AVF and 18% lower in those using an arteriovenous graft (AVG) for incident haemodialysis than in those using a CVC.…”

mentioning

confidence: 99%