Kidney Week

Abstract: TH-PO762

The Significance of a Maturing Fistula or Graft at HD Initiation

Session Information

• Hemodialysis: Vascular Access - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 603 Hemodialysis: Vascular Access

Authors

• McGill, Rita L., University of Chicago Medicine, Chicago, Illinois, United States

Rita L. McGill,

• Lacson, Eduardo K., Tufts University School of Medicine, Boston, Massachusetts, United States

Eduardo K. Lacson,

Background

Increasing use of fistulas (AVF) and grafts (AVG) is a national priority, especially for incident hemodialysis (HD) patients. One-quarter of patients who initiated HD with catheters (CVC) have an accompanying ‘maturing’ AVF or AVG. We examined the characteristics and one-year outcomes of these patients.

Methods

All patients initiating HD from 7/2010 – 12/2011 were assessed. Medical Evidence forms were used to determine baseline characteristics and vascular access at 1^st outpatient HD. HD claims were used to assess changes in vascular access, and treatment history files were used to identify deaths during the first year of HD.

Results

Among 52,573 patients initiating HD with CVCs, 12,201 (23.2%) had a maturing AVF/G. Compared to patients with CVC-only, patients with maturing AVF/G were more likely to be black (30.6 vs. 27.3%, P<0.01) and diabetic (61.7 vs 55.6%, P<0.01), but similar in age, sex, and body mass index. Patients with pre-HD nephrology care were twice as likely to have maturing AVF/G (31.1 vs. 15.6%, P<0.001). Over the first year, 10.9% of patients with maturing AVF/G died, 71.6% converted to AVF/G use, and 14.1% had CVC at one year. Among patients with CVC-alone, 23.0% died, 42.7% converted to AVF/G, and 23.8% had CVC at 1 year. Among patients who transitioned to AVF/G, median catheter-days were 131 (IQR=94-194) for patients with maturing access versus 195 (IQR=95-252) for those with CVC-only. The distributions of maturation times were unimodal for both groups.

Conclusion

HD initiation with a maturing AVF/AVG is associated with improved first-year outcomes relative to CVC as sole access, suggesting that vigorous efforts to secure access may be beneficial even in advanced CKD. Although a maturing AVF/AVG was associated with fewer catheter days, CVC use was prolonged in both groups. The reasons for prolonged CVC use merit further investigation.