Kidney Week

Abstract: FR-PO726

Outcomes of Coordinated Late Vascular Access 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

• Shah, Robin, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Robin Shah,

• Haddad, Nabil J., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Nabil J. Haddad,

• Boobes, Khaled, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Khaled Boobes,

• Vancleef, Sharon, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Sharon Vancleef,

• Agarwal, Anil K., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Anil K. Agarwal,

Background

Guidelines recommend timely pre-dialysis access creation to reduce incident catheter utilization which is associated with higher risk of hospitalization, procedures, mortality and cost. The process to achieve this goal is ambiguous and access coordination could be valuable, especially if the creation is late. Our program utilizes a hemodialysis (HD) access coordinator working closely with nephrologists and surgeons. This study analyzes how this system affects the outcomes of late access creation in our patient population.

Methods

Prospectively collected data from an electronic access database and the medical records of patients undergoing HD access creation between 2011-2017 prior to HD initiation from a single hospital system were analyzed.

Results

A total of 130 patients between the age of 22 to 89 years at the time of access placement had 146 accesses created. Seventy-eight (60%) were male, 52 (40%) female, 52% Caucasian and 42% African American. At time of access creation, median age was 60.5 and 56.5 years and median eGFR was 13.5 and 15.5 ml/min per 1.73 m² in the AVF and AVG group, respectively. A total of 131 AVF and 15 AVG were created. Seventy six patients started HD with a median time after creation of 109 and 131 days for non-diabetics and diabetics, respectively. At this time, 54 (42%) patients remain pre-HD-18 (33%) with failed access and 6 (11%) have died with a functioning access. Access success rate in those who initiated dialysis was 63%. HD was initiated with a catheter in 36% (46% in females vs. 30% in males). The average time to an interventional procedure after creation was shorter in non-diabetics (153 days) vs diabetics (197 days) and shorter in AVF (184 days) vs AVG (219 days). Interestingly, non-diabetics and patients under the age of 70 had a higher rate of access failure.

Conclusion

Nationally, 60-80% of incident HD patients have a catheter with fewer than 15% access placed less than 3 months prior to HD initiation. In our program, access placement occurred 3.5-4.5 months prior to dialysis initiation, later than recommended 6 months and at a very low eGFR. Despite that, our incident catheter rate was about half the national average. Our data emphasizes the importance of access coordination in order to reduce the incident catheter use and unnecessary access creations.