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-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

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 accessCatheterp-value
N of patients11491 
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-yr0.82 (0.75-0.90)1.32 (1.22-1.43)<0.001
All surgical procedures, per pt-yr0.34 (0.29-0.39)0.48 (0.42-0.55)0.001
All access procedures per pt-yr1.16 (1.07-1.25)1.80 (1.68-1.93)<0.001
CRB hospitalisation per 100 pt-yr2.22 (1.14-3.87)10.00 (7.29-13.37)<0.001