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Kidney Week

Abstract: FR-PO729

Incremental Costs of Arteriovenous Fistula (AVF) Non-Use Among US Hemodialysis Patients

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access


  • Thamer, Mae, MTPPI, Bethesda, Maryland, United States
  • Lee, Timmy C., Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Wasse, Monnie, Rush University Medical Center, Chicago, Illinois, United States
  • Glickman, Marc H., Hancock Jaffe Labs, Virginia Beach, Virginia, United States
  • Qian, Joyce Z., Johns Hopkins University, Potomac, Maryland, United States
  • Gottlieb, Daniel, Proteon Therapeutics, Waltham, Massachusetts, United States
  • Toner, Scott, Proteon Therapeutics, Waltham, Massachusetts, United States
  • Pflederer, Timothy A., Illinois Kidney Disease and Hypertension Center, Peoria, Illinois, United States

Despite the importance of vascular access (VA) for adequate hemodialysis (HD), few studies have examined the real world costs related to AVF maturation and use. We used national Medicare claims data to examine per patient VA costs over a 3 year period based on AVF use for dialysis among a cohort of dialysis patients.


We conducted a retrospective observational study using USRDS data for all incident Medicare patients who initiated dialysis from 2010-2011 and initiated dialysis with a mature AVF (n=2,704) or initiated dialysis with a CVC and underwent AVF creation in the next 6 months (n=3,901). Using a multidisciplinary expert panel, we identified VA-related diagnostic, imaging, endovascular, surgical, infection, hospitalization and anesthesia codes to calculate total VA costs paid by Medicare. Annualized per patient per year (PPPY) costs were calculated from the AVF creation date with costs censored at death or change in renal replacement modality. VA costs were calculated from the AVF creation date and were compared based on whether the AVF was successfully used for dialysis, as defined by the presence of at least one monthly ESRD billing claim in which AVF was recorded as the VA in use.


Regardless of timing of fistula insertion, AVFs that were not successfully used for dialysis resulted in incremental VA-related costs to Medicare of more than $20,000 PPPY in the first year after AVF creation, compared to AVFs that were successfully used. Incremental VA-related costs were also observed in the second and third year following AVF creation. In aggregate, annualized VA costs for three years after AVF creation are more than three times as high for patients whose fistula does not mature compared to those whose fistula matures.


Improvements in processes of care and technologies to enhance AVF maturation and use for dialysis as well as better patient selection should result in less morbidity with the potential for significant cost-savings.


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