Arteriovenous Vascular Access-Related Procedural Burden Among Incident Hemodialysis Patients in the United States.

Abstract

RATIONALE & OBJECTIVE\nAs the proportion of arteriovenous fistulae (AVF) compared to arteriovenous grafts (AVG) in the United States has increased, there has been a concurrent increase in interventions. We sought to explore AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis.\n\n\nSTUDY DESIGN\nObservational cohort study.\n\n\nSETTING & PARTICIPANTS\nPatients initiating hemodialysis from July 1, 2012, to December 31, 2014 and having a first time AVF or AVG placement between dialysis initiation and 1 year were identified (N=73,027) using the United States Renal Data System (USRDS).\n\n\nPREDICTORS\nPatient characteristics.\n\n\nOUTCOMES\nSuccessful AVF/AVG use and intervention procedure burden.\n\n\nANALYTICAL APPROACH\nFor each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modelling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.\n\n\nRESULTS\nDuring maturation phase, 13,989 of 57,275 (24.4%) patients in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person (pp). In the AVG group, 2,904 of 15,572 (18.4%) patients required intervention during maturation, with therapeutic interventional requirements of 0.28 pp. During maintenance phase, in the AVF group, 12,732 of 32,115 (39.6%) patients required intervention, with a therapeutic intervention rate of 0.93 per person-year (ppy). During maintenance phase, in the AVG group, 5,928 of 10,271 (57.7%) patients required intervention, with a therapeutic intervention rate of 1.87 ppy. For both phases, intervention rates for AVF tended to be higher on the East Coast, while those for AVG were more uniform geographically.\n\n\nLIMITATIONS\nThis study relies on administrative data, with monthly recording of access use.\n\n\nCONCLUSIONS\nDuring maturation, interventions for both AVF and AVG were relatively common. Once successfully matured, AVF had lower maintenance interventional requirements. During maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.