Abstract: FR-PO724
Evolution of Vascular Access in the First Year of Dialysis in the Irish Health System: A National Cohort Study
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
- Ahmed, Gasim, University Hospital Limerick, Liimerick, Ireland
- Browne, Leonard, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Hussein, Wael F., Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Plant, Liam, Cork University Hospital, Cork, Ireland
- Stack, Austin G., Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Background
Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVC), utilisation rates remain low among prevalent haemodialysis (HD) patients. The goal of this study was to determine the type and frequency of vascular access provision in the first year of dialysis and identify factors associated with conversion to AVF.
Methods
Data was obtained from the National Kidney Disease Clinical Patient Management System which tracks all patients with end stage kidney disease (ESKD) in Ireland. All adult patients who began HD in 2015 and 2016 and treated for at least 90 days were included. Data was captured on demographics factors, primary cause of ESKD (P-CKD), comorbid conditions, and biochemical indicators at day 90 (D90). Univariable and multivariable Cox regression quantified the risk of conversion from CVC to AVF with follow-up to D360 expressed as hazard ratios (HR), censored at change in modality and death.
Results
The study cohort included 610 patients, mean age 61.7yr (+15.8), 65% men and 76.7% were using a CVC for dialysis at D90. At D90, the likelihood of CVC varied significantly across HD centres (from 63 % to 91%, P<0.001) and these differences persisted when adjusting for case-mix. From D90 to D360, rates of AVF increased modestly from 23% to 41%, P<0.001 with a corresponding fall in CVC rates from 77% to 59%, P<0.001. Factors associated with conversion from CVC to AVF included age [HR, 0.45, (0.21- 0.96) for age > 78 vs < 60 years (ref)]; P-CKD-hypertension [HR, 0.19 (0.05- 0.72) and P-CKD-unknown [HR 0.25, (0.10- 0.61) vs P-CKD-polycystic kidney disease (ref)], increasing BMI, [HR1.05 (1.02- 1.08)] per unit increase, and HD centre (Figure 1).
Conclusion
CVCs remain the major type of vascular access in Irish HD patients with only a modest rise in AVF provision observed during the first year. Substantial centre variation exists at dialysis initiation and continues throughout the first year which is not fully explained by patient-level factors.
Funding
- Government Support - Non-U.S.