Abstract: FR-OR043

Procedural Burden Following Successful Arteriovenous Fistula Maturation in the United States

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Woodside, Kenneth J., University of Michigan, Ann Arbor, Michigan, United States
  • Ratkowiak, Kaitlyn, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Mukhopadhyay, Purna, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Schaubel, Douglas E., University of Michigan, Ann Arbor, Michigan, United States
  • Shahinian, Vahakn B., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Over the last decade, the number of arteriovenous fistula (AVF) in the prevalent US hemodialysis (HD) population has increased. We have previously reported that just under half of patients required interventional procedures for successful maturation of AVF. Herein, we sought to determine the procedural burden following successful AVF maturation (defined as first-use) among newly placed AVF in United States.

Methods

Using the United States Renal Data System (USRDS), Medicare claims and CROWNWeb data, we analyzed patients new to HD from 7/1/12 to 6/30/13 who had first-time AVF placements (after HD start) between 7/1/12 and 6/30/2014. Successful maturation was defined as documentation of first AVF use in the CROWNWeb monthly reporting of vascular access in use. Patients were followed until 12/31/2015.

Results

Among the 102,703 incident HD patients, there were 24,416 first-time AVF placements of which 72.6% were successfully utilized, 24.0% had no recorded use, and 3.4% were lost to follow-up. Of those AVF that successfully matured, 30.0% required interventions during the maturation phase ("assisted maturation"), with about half (55.1%) of these interventions requiring angioplasty. Rates of interventions during the maintenance phase, expressed as a rate per patient per year (ppy), are summarized in the Table. AVF that required interventional assistance to mature also had higher procedural burden for AVF maintenance.

Conclusion

While there have been improvements in AVF prevalence in the HD population, interventions on these AVF were exceedingly common. Future work will examine factors predisposing to greater requirements for intervention, cost effectiveness, patient outcomes, and comparisons with alternative vascular access types.

Funding

  • NIDDK Support