ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO474

Trends in Vascular Access Among Incident US Hemodialysis Patients Between 2015 and 2019

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

  • Allon, Michael, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Zhang, Yi, Medical Technology and Practice Patterns Institute, Bethesda, Maryland, United States
  • Thamer, Mae, Medical Technology and Practice Patterns Institute, Bethesda, Maryland, United States
  • Crews, Deidra C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Lee, Timmy C., Univ of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Vascular access guidelines recommend arteriovenous fistula (AVF) placement prior to hemodialysis (HD) initiation to decrease catheter (CVC) dependence. We quantified changes in vascular access between 2015-19.

Methods

Using the USRDS database, we identified 536,667 patients initiating HD from 2015-19. Patients starting HD with an AVF or with a CVC and a maturing AVF were considered to have undergone pre-HD AVF placement. We examined patient demographics, co-morbidities, functional status, insurance status, and duration of pre-HD nephrology care.

Results

AVF use at HD initiation decreased from 17% to 15% (12% relative decline) (Fig 1), and occurred across multiple patient subgroups. Pre-dialysis AVF placement decreased from 34 to 28% (18% relative decline). Patients with pre-dialysis AVF placement who used their AVF at dialysis initiation increased from 50 to 54%, indicating a higher AVF maturation rate. CVC use increased from 61 to 68% (11% relative increase) and AVG use remained constant at 3%. As compared to 2015, the adjusted odds ratio for initiation of HD with an AVF was 0.79 (95% CI 0.78-0.81) and for initiation with a CVC was 1.43 (1.20-1.45) in 2019. The best predictor of AVF placement and use was duration of pre-HD nephrology care. However, AVF use decreased and CVC use increased even among patients with prolonged pre-HD nephrology care (Fig 2).

Conclusion

AVF use decreased and CVC use increased at dialysis initiation from 2015-19.

Fig 1

Fig 2

Funding

  • Other NIH Support