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Kidney Week

Abstract: FR-PO334

Timing of Arteriovenous Access Creation in CKD Patients: The French CKD-REIN Study

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Alencar de Pinho, Natalia, CESP, Inserm U1018, Kidney and Heart Team, Villejuif, France
  • Lange, Celine, Biomedicine Agency, La Plaine Saint-Denis, France
  • Combe, Christian, CHU de Bordeaux, Bordeaux, France
  • Laville, Maurice, CHU de Lyon, Lyon, France
  • Fouque, Denis, University Claude Bernard, Pierre Benite, France
  • Frimat, Luc, CHU de Lyon, Lyon, France
  • Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France
  • Stengel, Benedicte, CESP, Inserm U1018, Kidney and Heart Team, Villejuif, France

Group or Team Name

  • The CKD-REIN cohort study
Background

Most guidelines on vascular access recommend to create an arteriovenous (AV) access in eligible patients when estimated glomerular filtration rate (eGFR) is 15-30 ml/min. We sought to assess whether clinical practices align with these recommendations.

Methods

We identified participants undergoing a first AV access creation in CKD-REIN, an ongoing prospective cohort study that includes 3033 adult patients under nephrology care for CKD in 40 clinics in France. We assessed the timing of AV access creation according to eGFR within a period of -90 to +30 days from surgery. We described patient characteristics and cumulative incidence of hemodialysis start and death according to the timing of AV access creation.

Results

Of the 335 participants who underwent a first AV access during a median follow-up of 2.6 years, 270 (81%) had contemporaneous information on eGFR level and were included in this analysis. Median eGFR at AV access creation was 13 ml/min (IQR 10-16). AV access creation at eGFR 15-30 ml/min (n= 83) vs <15 ml/min (n= 187) was more frequent in men then in women (78% vs 65%, p=0.03), and in patients with then without diabetes (63% vs 47%, p=0.02), cerebrovascular disease (26% vs 15%, p=0.04) and coronary artery disease (42% vs 24%, p=0.003). Conversely, participants with AV access creation at eGFR <15 had more nephrology visits over the last 6 months prior to surgery (29% vs 13% with ≥3 visits, p=0.001).The 2-year cumulative incidence of hemodialysis initiation was 79% in participants with eGFR 15-30 and 89% for participants with eGFR <15, with a median time from surgery of 11 (IQR 6-20) and 5 (2-11) months, respectively (p<0.001). Thirteen patients died before requiring hemodialysis. Cumulative incidence of death tended to be higher in the 15-30 (9%) vs <15 (4%) eGFR group, but this difference was not statistically significant (p=0.23).

Conclusion

In patients under nephrology care in France, later AV access creation seemed to be favored over the recommended earlier creation. This practice may limit unnecessary AV access creation (i.e. patients dying before requiring dialysis), but its impact on transitory catheter use is to be assessed.

Funding

  • Private Foundation Support