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Abstract: FR-PO903

First-Year Mortality among Patients Initiating Hemodialysis with a Functional Arteriovenous Fistula Compared with Peritoneal Dialysis

Session Information

Category: Dialysis

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

Authors

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

Comparison of initial outcomes between in-center HD and PD are subject to bias, as typically PD patients (pts) are younger, healthier, & may have received longer pre-ESRD care. Restricting comparisons to better prepared pts who initiate HD with a functional arteriovenous fistula at start of renal replacement (HDAVF) may minimize this bias.

Methods

Five annual cohorts (USRDS 2010-2014, CMS Form 2728) of incident HDAVF pts (N=81,850) & PD pts (N=47,830) were followed up to 1 year for the outcome of death. Death & time at risk for cohorts were determined in each of 12 consecutive 30-day segments, censoring for transplantation, switch to PD (or HD), recovery of renal function, loss to follow-up, or end of study. Death rates are expressed per 100 patient years (PY). Unadjusted and adjusted hazard ratios for death averaged over 2010-2014 were calculated for four 90-day risk periods.

Results

HD pts were on average older (64 vs 57 years), male (63.4% vs 56.8%), had received pre-ESRD care (89% vs 85.8%), & had greater comorbid burden at start of ESRD. The average unadjusted mortality rate for the HD cohort was higher, with 9.9 PY deaths in the first 30-days vs 5.6 PY deaths for PD. The hazard ratio of HD vs. PD in the unadjusted model was 1.6 (p <0.001) in the 0-90 day period, declining to 1.2 (p <0.001) post-180 days. In the adjusted model, the HR for first 30 days was 1.05 (p=0.34), & decreased to 0.88-8.82 (p <0.01) in the post-90 day period (Figure).

Conclusion

After accounting for pt characteristics, those who start renal replacement therapy on HDAVF appear to have a survival advantage over those that initiate with PD, particularly after 90 days. These findings could guide providers in advising the patients on modality & vascular access choice at dialysis start, have policy implications, & provide impetus for future research.

Funding

  • NIDDK Support