Abstract: TH-PO793

Effects of Access to Vascular Surgeons on Catheter Rates in Hemodialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Han, Hao, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Sor, Murat, Fresenius Vascular Care, Malvern, Pennsylvania, United States
  • Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Blanchard, Thomas C, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Rosen, Sophia, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Latif, Walead, Fresenius Vascular Care, Malvern, Pennsylvania, United States
  • Koh, Elsie, Fresenius Vascular Care, Malvern, Pennsylvania, United States
Background

The rates of central venous catheter (CVC) use in hemodialysis (HD) patients have been relatively unaltered over the last decade. In 2016, the United States Renal Data System estimated that 68% of incident HD patients utilize a CVC 90 days after starting HD, and approximately 20% of patients never transition to a permanent vascular access (VA). We aimed to investigate if availability of surgeons at outpatient VA centers proximal to the patients’ residence is associated with lower CVC rates in incident and prevalent HD patient populations.

Methods

We analyzed data from incident and prevalent patients treated by Fresenius Medical Care North America between January 1, 2016 and December 31, 2016. We selected patients who resided in a zip code that was within 5 miles of a Fresenius Vascular Care (FVC) VA center. Patients were stratified into groups based on whether they resided near a VA clinic with or without a vascular surgeon on site. We analyzed the percentage of catheters in incident patients and prevalent patients within these two groups.

Results

We observed that incident HD patients who lived proximal to a VA center without a surgeon were more likely to have a CVC (72% with a CVC) when compared to incident patients who resided near a VA center with a surgeon (66% with a CVC). Likewise, when analyzing all HD patients (incident and prevalent), 29% of patients who were living near a VA center without a surgeon used a CVC, as compared to 27% who lived close to a VA facility with a surgeon.

Conclusion

Our findings suggest that incident and prevalent HD patients residing in the proximities of an outpatient VA center with a surgeon on site are more likely to have a permanent access, possibly due to better access to care. Additional studies are necessary to confirm this observation and assess longitudinal trends for VA utilization.

Funding

  • Commercial Support