IMPORTANCE: Based on evidence of survival benefit when initiating hemodialysis (HD) via arteriovenous fistula (AVF) or arteriovenous graft (AVG) vs hemodialysis catheter (HC), the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative published practice guidelines in 1997 recommending 50% or greater AVF rates in incident HD patients. A decade after, lapses exist and the impact on HD outcomes is uncertain. OBJECTIVE: To assess the achievement of the practice goals for incident vascular access and the effects on HD outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using the US Renal Data System. All patients with end-stage renal disease in the United States without prior renal replacement therapy who had incident vascular access for HD created between January 1, 2006, and December 31, 2010 (N = 510 000) were included. MAIN OUTCOMES AND MEASURES: Incident vascular access use rates and mortality. Relative mortality was quantified using multivariable Cox proportional hazard models. Coarsened exact matching and propensity score-matching techniques were used to better account for confounding by indication. RESULTS: Of 510 000 patients included in this study, 82.6% initiated HD via HC, 14.0% via AVF, and 3.4% via AVG. Arteriovenous fistula use increased only minimally, from 12.2% in 2006 to 15.0% in 2010. Patients initiating HD with AVF had 35% lower mortality than those with HC (adjusted hazard ratio, 0.65; 95% CI, 0.64-0.66; P < .001). Those initiating HD with AVF had 23% lower mortality than those initiating with an HC while awaiting maturation of an AVF (adjusted hazard ratio, 0.77; 95% CI, 0.76-0.79; P < .001). CONCLUSIONS AND RELEVANCE: Current incident AVF practice falls exceedingly short years after recommendations were made in 1997. The impact of this shortcoming on mortality for patients with end-stage renal disease is enormous. Functioning permanent access at initiation of HD confers lower mortality even compared with patients temporized with an HC while awaiting maturation of permanent access. A change of current policies and structured multidisciplinary efforts are required to establish matured fistulae prior to HD to ameliorate this deficit in delivering care.
IMPORTANCE: Based on evidence of survival benefit when initiating hemodialysis (HD) via arteriovenous fistula (AVF) or arteriovenous graft (AVG) vs hemodialysis catheter (HC), the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative published practice guidelines in 1997 recommending 50% or greater AVF rates in incident HDpatients. A decade after, lapses exist and the impact on HD outcomes is uncertain. OBJECTIVE: To assess the achievement of the practice goals for incident vascular access and the effects on HD outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using the US Renal Data System. All patients with end-stage renal disease in the United States without prior renal replacement therapy who had incident vascular access for HD created between January 1, 2006, and December 31, 2010 (N = 510 000) were included. MAIN OUTCOMES AND MEASURES: Incident vascular access use rates and mortality. Relative mortality was quantified using multivariable Cox proportional hazard models. Coarsened exact matching and propensity score-matching techniques were used to better account for confounding by indication. RESULTS: Of 510 000 patients included in this study, 82.6% initiated HD via HC, 14.0% via AVF, and 3.4% via AVG. Arteriovenous fistula use increased only minimally, from 12.2% in 2006 to 15.0% in 2010. Patients initiating HD with AVF had 35% lower mortality than those with HC (adjusted hazard ratio, 0.65; 95% CI, 0.64-0.66; P < .001). Those initiating HD with AVF had 23% lower mortality than those initiating with an HC while awaiting maturation of an AVF (adjusted hazard ratio, 0.77; 95% CI, 0.76-0.79; P < .001). CONCLUSIONS AND RELEVANCE: Current incident AVF practice falls exceedingly short years after recommendations were made in 1997. The impact of this shortcoming on mortality for patients with end-stage renal disease is enormous. Functioning permanent access at initiation of HD confers lower mortality even compared with patients temporized with an HC while awaiting maturation of permanent access. A change of current policies and structured multidisciplinary efforts are required to establish matured fistulae prior to HD to ameliorate this deficit in delivering care.
Authors: Kenneth J Woodside; Sarah Bell; Purna Mukhopadhyay; Kaitlyn J Repeck; Ian T Robinson; Ashley R Eckard; Sudipta Dasmunshi; Brett W Plattner; Jeffrey Pearson; Douglas E Schaubel; Ronald L Pisoni; Rajiv Saran Journal: Am J Kidney Dis Date: 2018-02-09 Impact factor: 8.860
Authors: Courtenay M Holscher; Satinderjit S Locham; Christine E Haugen; Sunjae Bae; Dorry L Segev; Mahmoud B Malas Journal: J Nephrol Date: 2019-01-02 Impact factor: 3.902
Authors: Meera N Harhay; Dawei Xie; Xiaoming Zhang; Chi-Yuan Hsu; Eric Vittinghoff; Alan S Go; Stephen M Sozio; Jacob Blumenthal; Stephen Seliger; Jing Chen; Rajat Deo; Mirela Dobre; Sanjeev Akkina; Peter P Reese; James P Lash; Kristine Yaffe; Manjula Kurella Tamura Journal: Am J Kidney Dis Date: 2018-05-02 Impact factor: 8.860
Authors: Juan C Duque; Marwan Tabbara; Laisel Martinez; Angela Paez; Guillermo Selman; Loay H Salman; Omaida C Velazquez; Roberto I Vazquez-Padron Journal: Surgery Date: 2017-12-11 Impact factor: 3.982
Authors: Shipra Arya; Taylor A Melanson; Elizabeth L George; Kara A Rothenberg; Manjula Kurella Tamura; Rachel E Patzer; Jason M Hockenberry Journal: J Am Soc Nephrol Date: 2020-01-15 Impact factor: 10.121