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Abstract: FR-PO483

Clinical and Demographic Characteristics Associated with Arteriovenous Access-Related Infections in US Patients Initiating Hemodialysis

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

  • Pulgar, Sonia J., Humacyte Global Inc, Durham, North Carolina, United States
  • Panaccio, Mary Prince, Humacyte Global Inc, Durham, North Carolina, United States
  • Willetts, Joanna, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Hussain, Mohamad Anas, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Chaudhuri, Sheetal, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Niklason, Laura E., Humacyte Global Inc, Durham, North Carolina, United States
Background

End-stage renal disease (ESRD) patients are dependent on successful arteriovenous (AV) access for continual hemodialysis (HD). Infection risk can be elevated due to AV access type and may vary by patient factors and if severe – this can lead to hospitalization and even death. The study objective was to describe demographic and clinical factors associated with access-related infections (AVI) for patients initiating HD.

Methods

Patients aged 18+ years initiating HD at Fresenius Kidney Care (FKC) clinics from 2016 to 2018 were followed for up to 18 months, with censoring due to death or loss to follow-up. Patient characteristics were compared between those who developed an AVI (defined as graft infection or bloodstream infection) to those who did not. Data were stratified by gender, age range, and diabetes status. Univariate models were constructed and odds-ratios (OR) with 95% confidence intervals (CI) were calculated.

Results

Among the 87,707 HD incident patients, 43% were female, 56% were white, with mean age 63 yrs. Incidence of AVI was highest among the youngest age group (18-45), particularly, women (Figure 1). At 18 months, women aged 18-45 (OR: 1.3, CI: 1.2-1.35 vs. aged 45-64) and patients with type 1 diabetes (T1DM) were at high risk for AVI (OR: 1.4, CI: 1.2-1.6 vs. non-DM patients) (Figure 2). AVI risk was highest among younger women with T1DM (OR: 1.65, CI: 1.24 - 2.2 vs similarly aged non-DM patients). Patients with multiple access changes whose initial vascular access was an AV graft were among the highest risk compared to the overall population. Indigenous patients also had elevated AVI risk (23% by month 18) and were more likely to have multiple AV access changes.

Conclusion

Younger women with T1DM had the highest AVI risks compared to those without DM, men, and older patients. Multivariate modeling of this sub-population is required to assess the interplay of other factors mediating the risk of these poorer outcomes.

Funding

  • Commercial Support – Humacyte, Inc.