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Kidney Week

Abstract: FR-PO473

Increase in Hemodialysis Initiation with a Catheter

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Roetker, Nicholas S., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Liu, Jiannong, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

Reliable vascular access is essential for hemodialysis (HD). Initiating HD with an arteriovenous (AV) access rather than a catheter is preferred for most patients. We modeled recent trends in the percentage of patients initiating HD with a catheter and no maturing AV access.

Methods

Using data from the US Renal Data System, we included all adults initiating maintenance HD between January 1, 2012 and September 30, 2022. We estimated the proportion initiating HD with a catheter only in each quarter, identifying a breakpoint in the temporal trend using segmented linear regression. We then fit a generalized piecewise linear model with a binomial distribution and identity link to estimate the temporal trend in catheter use before and after this breakpoint, with adjustment for age, sex, race/ethnicity, and seasonal effects.

Results

The analysis included 1,169,323 adults. A breakpoint was identified in March 2017 (Figure). In 2012, the overall proportion of patients initiating with a catheter only was roughly 60%. This proportion increased by 0.5% (95% CI 0.4-0.6%) per year, on average, until Q1-2017. After the breakpoint, the proportion increased more rapidly, by an average of 2.5% (95% CI 2.4–2.6%) per year, with nearly 75% of patients initiating HD with a catheter and no maturing AV access by 2022. Trends in catheter use before and after March 2017 were similar across categories of age, sex, and race/ethnicity. Other than a transient increase during Q2-2020, there was no enduring change in the pattern of catheter use during the COVID-19 pandemic.

Conclusion

We observed a concerning increasing trend in HD initiation with a catheter in the absence of a maturing permanent access between 2017 and 2022. The emergence of this trend in 2017 coincided with reductions for vascular access services in the Medicare Part B Physician Fee Schedule. Given further reductions in vascular access-related reimbursements occurred in 2023, trends in catheter use should be carefully monitored.

Funding

  • NIDDK Support