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Abstract: PO1044

Arteriovenous Access Creation and Re-Intervention Before Starting Hemodialysis

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Kolla, Epiphane Esso-dong, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
  • Coscas, Raphael, Div. Vascular Surgery, Ambroise Paré University Hospital, APHP, Boulogne Billancourt, France
  • Couchoud, Cécile, Biomedicine Agency, La Plaine Saint Denis, France
  • Massy, Ziad, Div. Nephrology, Ambroise Paré University Hospital, APHP, Boulogne Billancourt, France
  • Stengel, Benedicte, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
  • Metzger, Marie, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
  • Alencar de Pinho, Natalia, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
Background

Arteriovenous fistulae and grafts are preferred to catheters for patients undergoing maintenance hemodialysis. They require early creation to be functional at time of hemodialysis initiation, but may need re-interventions to mature and remain functional.

Methods

Using data from the French REIN Registry linked to the national healthcare system database (Système National des Données de Santé - SNDS), we assessed: A) the timing of first arteriovenous access creation before hemodialysis initiation; B) vascular access re-intervention rates before hemodialysis initiation; and C) the frequency of catheter use at hemodialysis initiation in 43,495 matched incident patients from 2010 through 2015.

Results

Median age was 71 years, 64% were men, 43% had diabetes, and 33% started hemodialysis urgently. Half (51%) underwent a first arteriovenous access creation: a fistula in 21,240 patients, created a median of 5 months (IQR, 2-12), and a graft, in 741 patients, 3 (1-8) months before hemodialysis initiation. Among patients with a first fistula attempt, 30% underwent at least one vascular access re-intervention before hemodialysis initiation, versus 21% among those with a first graft attempt (p<0.001). The types of intervention substantially differed according to vascular access (Figure). When dialysis start was urgent, catheter was used in 43% of patients in both access groups (p=0.86); when it was not, catheter was used in 12 and 14% of patients with a first fistula or graft attempt, respectively (p=0.15).

Conclusion

In incident hemodialysis patients in France, fistula is typically the first attempted arteriovenous access. Early arteriovenous access creation prevents from using catheter at dialysis initiation in a majority of patients, but requires close monitoring of potential complications.

Funding

  • Government Support – Non-U.S.