Abstract: FR-PO728
Clinical Outcomes and Economic Impact of Starting Hemodialysis with a Catheter (CVC) vs a Permanent Access After Pre-ESRD Arteriovenous Fistula (AVF) Creation
Session Information
- Dialysis: Vascular Access - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Shariff, Saad Mohammed, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Albalas, Alian, UAB, Birmingham, Alabama, United States
- Allon, Michael, University of Alabama at Birmingham, Birmingham, Alabama, United States
Background
Patients progressing to ESRD frequently have an AVF placed pre-ESRD, but may initiate HD with a CVC if the access is not yet suitable for use. Little is known about the clinical outcomes and economic impact of such patients initiating HD with a CVC vs a permanent access.
Methods
We identified 205 patients who received an AVF pre-ESRD between 2006 and 2012, and started hemodialysis within 2 years. Of these, 91 initiated HD with a CVC and 114 with a permanent access. We compared these two groups in terms of demographics, co-morbidities, the frequency of percutaneous access procedures, surgical access procedures, total access procedures, hospitalizations due to catheter related bacteremia (CRB), and annual cost of vascular access management from ESRD to the end of patient follow-up.
Results
The groups initiating HD with a CVC vs a permanent access were similar in terms of age, sex, race, diabetes, vascular disease, and heart failure. As compared to patients initiating HD with a permanent access, those initiating with a CVC had a 61% greater annual frequency of percutaneous access procedures, a 41% greater frequency of surgical access procedures, a 55% greater frequency of total access procedures, and a 5-fold higher frequency of CRB hospitalizations (Table 1). Patients initiating HD with a CVC incurred a median annual cost of access management that was $2,930 higher ($5,478 [2,011-12,497) vs $2,548 [924-6717], p<0.001).
Conclusion
Among patients with pre-ESRD AVF creation, those initiating HD with CVC had substantially more frequent percutaneous, surgical, and total access procedures, as well as CRB hospitalizations. The annual cost of access management was substantially higher in those initiating HD with a CVC vs a permanent access.
Frequency of post-ESRD access procedures and CRB hospitalizations in patients starting HD with permanent access vs a CVC after pre-ESRD AVF surgery.
| Permanent access | Catheter | p-value | |
| N of patients | 114 | 91 | |
| Years of follow-up, median [IQR] | 4.6 [2.1-6.7] | 4.7 [2.2-7.5] | 0.82 |
| All percutaneous procedures per pt-yr | 0.82 (0.75-0.90) | 1.32 (1.22-1.43) | <0.001 |
| All surgical procedures, per pt-yr | 0.34 (0.29-0.39) | 0.48 (0.42-0.55) | 0.001 |
| All access procedures per pt-yr | 1.16 (1.07-1.25) | 1.80 (1.68-1.93) | <0.001 |
| CRB hospitalisation per 100 pt-yr | 2.22 (1.14-3.87) | 10.00 (7.29-13.37) | <0.001 |