ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO730

Procedural Burden Following Arteriovenous Graft Placement Among Incident Hemodialysis Patients in the United States

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Woodside, Kenneth J., University of Michigan, Ann Arbor, Michigan, United States
  • Repeck, 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, 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

We previously reported that half of patients required interventional procedures for successful maturation of arteriovenous fistula (AVF), with additional post-maturation burden of 0.40 and 0.52 procedures per person-year (ppy) for those with natural and assisted maturation, respectively (p<0.0001). Herein, we sought to determine the procedural burden during ‘maturation’ and maintenance phases of newly placed arteriovenous grafts (AVG).

Methods

Using data from the United States Renal Data System (USRDS), patients new to HD from 7/1/12 to 12/31/14 with initial billing codes for AVG placements (since HD start) from 7/1/12 to 12/31/15 were included. Successful maturation was defined as first documentation of AVG use in CROWNWeb monthly data. Patients were followed until 12/31/2016, or 1 year post-AVG placement.

Results

Among 258,731 incident HD patients, there were 23,629 first-time AVG placements. Of these, 59.9% were successfully utilized, 28.7% had no recorded use, and 11.3% were lost to follow-up (Table). Of successfully utilized AVG, 18.2% required interventions during the maturation phase, for 0.31 procedures per person (pp), while 43.3% of unsuccessful AVG underwent intervention, for 1.03 pp (p<0.0001). Following successful first use, those with assisted maturation underwent 2.05 ppy, while those without assistance demonstrated 1.59 ppy (p<0.0001).

Conclusion

Surprisingly, AVG utilization following placement was lower than anticipated. Interventions on AVG were common for both maturation and maintenance. While the maturation procedural burden for AVG compares favorably with AVF, the maintenance phase procedural burden is much higher, implying potential logistic and cost advantages of AVF over AVG.

Funding

  • NIDDK Support