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Abstract: PO1108

Pre-Dialysis Transition Predictors of Vascular Access Type in 73,928 Veterans Who Started Hemodialysis Therapy Between 2007-2015

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Studies showed dialysis patients with central venous catheter (CVC) had worse outcomes compared to arterio-venous fistula/graft (AVF/AVG) patients. It is hypothesized that a CVC may be a surrogate for sicker patients. From the US Veteran transition of care (TC-CKD) cohort, we sought to characterize factors associated with initiating dialysis with CVC vs. AVF/AVG access type within a year prior to dialysis transition.

Methods

Among US veterans who transitioned to end-stage renal disease (ESRD) from 2007 to 2015, we examined predictors of access type using adjusted logistic regression. An adjusted reverse cox model was used to examine predictors at time of dialysis initiation to identify time to access placement surgery prior to transition.

Results

Logistic regression showed patients with higher Charlson comorbidity index, multiple preexisting comorbidities, and higher hospital and primary care visit before access surgery, had a higher odds of receiving CVC verses AVF or AVG. Among a subset of 28,759 patients, those who were older, female, black, had dementia, and had higher serum phosphorus, white blood cells, and eGFR are more likely to have CVC. Patients who were married, had higher serum albumin, calcium, sodium, hemoglobin, had slower 1 year eGFR decline, and higher nephrology visits, were less likely to have CVC. Fully adjusted reverse cox regression showed patients with higher serum alkaline phosphatase and blood urea nitrogen were more likely to have AVF/AVG placed closer to time of transition. Among 44,558 patients who had at least 1 VA primary care visit in the year prior to dialysis, patients with ≥2 nephrology visits were more likely to have a AVF/AVG placement surgery in the year prior to transition [figure].

Conclusion

We found that starting dialysis with CVC is a surrogate of adverse outcomes and faster CKD progression, while frequent nephrology visits in a year prior to transition is associated to higher likelihood of AVF/AVG placement.

Figure: Time for dialysis transition back to AVF/AVG placement surgery prior to transition.