Evolution of Vascular Access among Incident Hemodialysis Patients during the First Year: A National Study

Abstract

Background: Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVC), utilisation rates remain low among prevalent haemodialysis (HD) patients. The goal of this study was to determine the evolution of vascular access type in the first year of dialysis and identify factors associated with conversion from CVC to a functioning AVF. Methods: We studied adult patients (n=610) who began HD between the 01/01/2015 and 31/12/2016 and were treated for at least 90 days using data from the National Kidney Disease Clinical Patient Management System in the Irish Health System. Prevalence of vascular access type was determined at day 90 and 360 following dialysis initiation and at 30-day intervals. Multivariable logistic regression explored factors association with CVC at day 90, and Cox regression evaluated predictors of conversion from CVC to AVF on day 360. Results: CVC use was present in 77% of incident patients at day 90 with significant variation across HD centres (from 63 % to 91%, P 77yrs vs referent], for patients with lower BMI [HR 0.95, (0.93- 0.98) per unit decrease in BMI], and varied significantly across HD centres [from HR 0.25, (0.08-0.74) to 2.09 (1.04-4.18)]. Conclusion: CVC are the predominant type of vascular access observed during the first year of dialysis with low conversion rates from CVC to AVF. Substantial centre variation exists in the Irish health system that is not explained by patient-related factors alone.