Abstract: SA-PO0372
Relationships Between Hemodialysis Centers and Access Surgeons and Central Venous Catheter Usage: A Retrospective Cohort Study
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bailoor, Kunal, University of Michigan, Ann Arbor, Michigan, United States
- Oerline, Mary K., University of Michigan, Ann Arbor, Michigan, United States
- Gurnani, Sunayna, University of Michigan, Ann Arbor, Michigan, United States
- Guro, Paula A, University of Michigan, Ann Arbor, Michigan, United States
- Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
- Hollingsworth, John M., University of Florida, Gainesville, Florida, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
Background
Reducing central venous catheter usage in patients with end stage kidney disease on hemodialysis remains an important priority. Previous reports have shown that in novel care models (e.g., the Comprehensive ESRD Care model), where formal partnerships existed between hemodialysis facilities and vascular access surgeons, there were reduced rates of central venous catheter use. We hypothesized that closer relationships between hemodialysis facilities and vascular access surgeons would decrease the use of central venous catheters
Methods
We conducted a national retrospective cohort study involving 109,293 patients with end stage kidney disease on maintenance hemodialysis from 01/01/2017 through 12/31/2018, across 4,402 dialysis facilities. Our exposure was facility-level vascular access surgeon Herfindahl-Hirschman Index, an established measure of market concentration used as a proxy for closer relationships between hemodialysis facilities and vascular access surgeons (with higher index scores suggesting closer relationships). Our primary outcome was greater than 90 days of continuous central venous catheter use in 2018. We used a mixed effects logistic regression model including patient-level covariates, facility-level covariates, and facility random effects. Dialysis facilities were divided into quartiles based on increasing Herfindahl-Hirschman Index. Multiple sensitivity analyses were conducted using similar models
Results
Patients in facilities in the highest Herfindahl-Hirschman Index quartile were less likely to have continuous catheter use for over 90 days on dialysis than those in the lowest quartile (odds ratio (OR), 0.81; 95% confidence interval [CI], 0.75 to 0.87; p <0.01). This effect was replicated in multiple sensitivity analyses
Conclusion
Partnerships between dialysis facilities and access surgeons, as measured by Herfindahl-Hirschman Index, were associated with lower rates of central venous catheter usage
Funding
- NIDDK Support