Clinical significance of maturing vascular access for incident hemodialysis patients
Andrea Liu, Ryan M Song, Jacob Ryno, Mary Hammes, Peter Angelos, Ted A Skolarus, Rita L McGillBackground:
Reliable vascular access is required for hemodialysis (HD). Central venous catheters (CVC) can be used immediately, but are traditionally associated with increased mortality compared to arteriovenous fistulas or grafts (AVF/AVG). Immature fistulas or grafts may or may not become usable; their impact on long-term mortality or transplant has not been defined.
Methods:
Adult incident HD patients entering the United States Renal Data System between 1/2018 and 12/2019 were identified, and included if still on HD at day 90. Initial dialysis accesses were categorized as mature AVF/AVG, CVC-only, or CVC with an fistula or graft that was not ready for use (CVC-plus). Cox models were used to examine the associations between access type and patient mortality, and logistic models for kidney transplant waitlist appearance, using propensity-matched samples. CVC-plus was the reference group for all models.
Results:
Among 214,673 patients, 66% had CVC-only, 15% CVC-plus, and 19% AVF/AVG. Over median follow up of 30 months, 45% died and 5% received kidney transplants. Compared to patients with CVC-plus, having CVC-only was associated with increased death (HR = 1.31, 95% CI = 1.29–1.35,
Conclusions:
Initiating HD with CVC-plus was advantageous compared to CVC-only, but outcomes were inferior to those of patients initiating HD with mature AVF/AVG.