Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease
The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care in a representative US population of patients with end-stage kidney disease, including by age, race, and gender. All Medicare beneficiaries aged >...
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| Veröffentlicht in: | The American journal of cardiology 2025-01, Vol.234, p.79-86 |
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| container_title | The American journal of cardiology |
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| creator | Kong, Nathan W. Kim, Joseph M. Krawisz, Anna K. Heindel, Patrick Tale, Archana Song, Yang Weinstein, Jeffrey L. Hussain, Mohamad A. Secemsky, Eric A. |
| description | The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care in a representative US population of patients with end-stage kidney disease, including by age, race, and gender. All Medicare beneficiaries aged >20 years who underwent AVF graft creation for end-stage kidney disease between 2017 and 2019 were included for analysis. The primary end points included primary patency, primary assisted patency, postintervention patency, and fistula functionality up to 1 year after AVF placement. The secondary end point included admission for an associated adverse event after AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at 1 year, 31.5%. At 1 year, the primary assisted patency rate, postintervention patency, and fistula use were 70.4%, 30.2%, and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 to 59 years: hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.95 to 1.06, p = 0.84 or age ≥60 years: HR 0.99, 95% CI 0.93 to 1.04, p = 0.61) with the reference of age group 20 to 39 years. Women were at greater risk of experiencing primary patency failure than were men (HR 1.16, 95% CI 1.14 to 1.20, p |
| doi_str_mv | 10.1016/j.amjcard.2024.10.006 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3120596242</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S000291492400732X</els_id><sourcerecordid>3142029657</sourcerecordid><originalsourceid>FETCH-LOGICAL-c271t-b193acac52e82b7249eeb36ac7c3d08e4429cb3d247955ee295c693f7c7e246f3</originalsourceid><addsrcrecordid>eNqFkc1u1DAUhS1ERYfCI4AisWGTwX-JxytUhragtuoCEEvLcW7KjRK72E5R374ezcCCTVeWj757rn0OIW8YXTPK2g_j2s6js7Ffc8pl0daUts_Iim2Urplm4jlZUUp5rZnUx-RlSmO5Mta0L8ix0FIqxdmK4M2SXZghVedhmsIf9LfVacwQMdyDD0vRMeVlstU2gs0YfIW-uoYey26oPoGHAR3aiMXiJ-Zf1Znv62_Z3kJ1ib2Hh-ozJrAJXpGjwU4JXh_OE_Lj_Oz79kt9dXPxdXt6VTuuWK47poV11jUcNrxTXGqATrTWKSd6ugEpuXad6LlUumkAuG5cq8WgnAIu20GckPd737sYfi-QspkxOZgm66H8xwjGaaNbLnlB3_2HjmGJvryuULLkqttGFarZUy6GlCIM5i7ibOODYdTsujCjOXRhdl3s5NJFmXt7cF-6Gfp_U3_DL8DHPQAljnuEaJJD8K6EG8Fl0wd8YsUjJS2dGw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3142029657</pqid></control><display><type>article</type><title>Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Kong, Nathan W. ; Kim, Joseph M. ; Krawisz, Anna K. ; Heindel, Patrick ; Tale, Archana ; Song, Yang ; Weinstein, Jeffrey L. ; Hussain, Mohamad A. ; Secemsky, Eric A.</creator><creatorcontrib>Kong, Nathan W. ; Kim, Joseph M. ; Krawisz, Anna K. ; Heindel, Patrick ; Tale, Archana ; Song, Yang ; Weinstein, Jeffrey L. ; Hussain, Mohamad A. ; Secemsky, Eric A.</creatorcontrib><description>The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care in a representative US population of patients with end-stage kidney disease, including by age, race, and gender. All Medicare beneficiaries aged >20 years who underwent AVF graft creation for end-stage kidney disease between 2017 and 2019 were included for analysis. The primary end points included primary patency, primary assisted patency, postintervention patency, and fistula functionality up to 1 year after AVF placement. The secondary end point included admission for an associated adverse event after AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at 1 year, 31.5%. At 1 year, the primary assisted patency rate, postintervention patency, and fistula use were 70.4%, 30.2%, and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 to 59 years: hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.95 to 1.06, p = 0.84 or age ≥60 years: HR 0.99, 95% CI 0.93 to 1.04, p = 0.61) with the reference of age group 20 to 39 years. Women were at greater risk of experiencing primary patency failure than were men (HR 1.16, 95% CI 1.14 to 1.20, p <0.001), and Black patients were at greater risk of experiencing primary patency failure than were White patients (HR 1.34, 95% CI 1.31 to 1.38, p <0.001). The cumulative incidence of admissions for adverse events was 32.6% at 1 year. In conclusion, our findings suggest that the real-world AVF patency rates remain low, with disproportionately low rates in women and Black patients.</description><identifier>ISSN: 0002-9149</identifier><identifier>ISSN: 1879-1913</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2024.10.006</identifier><identifier>PMID: 39447721</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age ; Age groups ; Aged ; arteriovenous fistulas ; Arteriovenous Shunt, Surgical ; Costs ; End-stage renal disease ; Female ; Females ; Fistula ; Fistulae ; Gender ; Health care expenditures ; health disparities ; hemodialysis ; Humans ; Hypertension ; Intervention ; Ischemia ; Kidney diseases ; Kidney Failure, Chronic - therapy ; Kidney transplantation ; Male ; Medicaid ; Medical prognosis ; Medicare ; Middle Aged ; Multivariate analysis ; Patients ; Population studies ; Quality of life ; Regression analysis ; Renal Dialysis ; Renal replacement therapy ; Retrospective Studies ; Sepsis ; Stroke ; United States - epidemiology ; vascular access ; Vascular Patency ; Venous access ; Women</subject><ispartof>The American journal of cardiology, 2025-01, Vol.234, p.79-86</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><rights>2024. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c271t-b193acac52e82b7249eeb36ac7c3d08e4429cb3d247955ee295c693f7c7e246f3</cites><orcidid>0000-0002-2477-9181</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2024.10.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39447721$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kong, Nathan W.</creatorcontrib><creatorcontrib>Kim, Joseph M.</creatorcontrib><creatorcontrib>Krawisz, Anna K.</creatorcontrib><creatorcontrib>Heindel, Patrick</creatorcontrib><creatorcontrib>Tale, Archana</creatorcontrib><creatorcontrib>Song, Yang</creatorcontrib><creatorcontrib>Weinstein, Jeffrey L.</creatorcontrib><creatorcontrib>Hussain, Mohamad A.</creatorcontrib><creatorcontrib>Secemsky, Eric A.</creatorcontrib><title>Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care in a representative US population of patients with end-stage kidney disease, including by age, race, and gender. All Medicare beneficiaries aged >20 years who underwent AVF graft creation for end-stage kidney disease between 2017 and 2019 were included for analysis. The primary end points included primary patency, primary assisted patency, postintervention patency, and fistula functionality up to 1 year after AVF placement. The secondary end point included admission for an associated adverse event after AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at 1 year, 31.5%. At 1 year, the primary assisted patency rate, postintervention patency, and fistula use were 70.4%, 30.2%, and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 to 59 years: hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.95 to 1.06, p = 0.84 or age ≥60 years: HR 0.99, 95% CI 0.93 to 1.04, p = 0.61) with the reference of age group 20 to 39 years. Women were at greater risk of experiencing primary patency failure than were men (HR 1.16, 95% CI 1.14 to 1.20, p <0.001), and Black patients were at greater risk of experiencing primary patency failure than were White patients (HR 1.34, 95% CI 1.31 to 1.38, p <0.001). The cumulative incidence of admissions for adverse events was 32.6% at 1 year. In conclusion, our findings suggest that the real-world AVF patency rates remain low, with disproportionately low rates in women and Black patients.</description><subject>Adult</subject><subject>Age</subject><subject>Age groups</subject><subject>Aged</subject><subject>arteriovenous fistulas</subject><subject>Arteriovenous Shunt, Surgical</subject><subject>Costs</subject><subject>End-stage renal disease</subject><subject>Female</subject><subject>Females</subject><subject>Fistula</subject><subject>Fistulae</subject><subject>Gender</subject><subject>Health care expenditures</subject><subject>health disparities</subject><subject>hemodialysis</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Intervention</subject><subject>Ischemia</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidney transplantation</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medical prognosis</subject><subject>Medicare</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Population studies</subject><subject>Quality of life</subject><subject>Regression analysis</subject><subject>Renal Dialysis</subject><subject>Renal replacement therapy</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Stroke</subject><subject>United States - epidemiology</subject><subject>vascular access</subject><subject>Vascular Patency</subject><subject>Venous access</subject><subject>Women</subject><issn>0002-9149</issn><issn>1879-1913</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAUhS1ERYfCI4AisWGTwX-JxytUhragtuoCEEvLcW7KjRK72E5R374ezcCCTVeWj757rn0OIW8YXTPK2g_j2s6js7Ffc8pl0daUts_Iim2Urplm4jlZUUp5rZnUx-RlSmO5Mta0L8ix0FIqxdmK4M2SXZghVedhmsIf9LfVacwQMdyDD0vRMeVlstU2gs0YfIW-uoYey26oPoGHAR3aiMXiJ-Zf1Znv62_Z3kJ1ib2Hh-ozJrAJXpGjwU4JXh_OE_Lj_Oz79kt9dXPxdXt6VTuuWK47poV11jUcNrxTXGqATrTWKSd6ugEpuXad6LlUumkAuG5cq8WgnAIu20GckPd737sYfi-QspkxOZgm66H8xwjGaaNbLnlB3_2HjmGJvryuULLkqttGFarZUy6GlCIM5i7ibOODYdTsujCjOXRhdl3s5NJFmXt7cF-6Gfp_U3_DL8DHPQAljnuEaJJD8K6EG8Fl0wd8YsUjJS2dGw</recordid><startdate>20250101</startdate><enddate>20250101</enddate><creator>Kong, Nathan W.</creator><creator>Kim, Joseph M.</creator><creator>Krawisz, Anna K.</creator><creator>Heindel, Patrick</creator><creator>Tale, Archana</creator><creator>Song, Yang</creator><creator>Weinstein, Jeffrey L.</creator><creator>Hussain, Mohamad A.</creator><creator>Secemsky, Eric A.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2477-9181</orcidid></search><sort><creationdate>20250101</creationdate><title>Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease</title><author>Kong, Nathan W. ; 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All Medicare beneficiaries aged >20 years who underwent AVF graft creation for end-stage kidney disease between 2017 and 2019 were included for analysis. The primary end points included primary patency, primary assisted patency, postintervention patency, and fistula functionality up to 1 year after AVF placement. The secondary end point included admission for an associated adverse event after AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at 1 year, 31.5%. At 1 year, the primary assisted patency rate, postintervention patency, and fistula use were 70.4%, 30.2%, and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 to 59 years: hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.95 to 1.06, p = 0.84 or age ≥60 years: HR 0.99, 95% CI 0.93 to 1.04, p = 0.61) with the reference of age group 20 to 39 years. Women were at greater risk of experiencing primary patency failure than were men (HR 1.16, 95% CI 1.14 to 1.20, p <0.001), and Black patients were at greater risk of experiencing primary patency failure than were White patients (HR 1.34, 95% CI 1.31 to 1.38, p <0.001). The cumulative incidence of admissions for adverse events was 32.6% at 1 year. In conclusion, our findings suggest that the real-world AVF patency rates remain low, with disproportionately low rates in women and Black patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39447721</pmid><doi>10.1016/j.amjcard.2024.10.006</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2477-9181</orcidid></addata></record> |
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| subjects | Adult Age Age groups Aged arteriovenous fistulas Arteriovenous Shunt, Surgical Costs End-stage renal disease Female Females Fistula Fistulae Gender Health care expenditures health disparities hemodialysis Humans Hypertension Intervention Ischemia Kidney diseases Kidney Failure, Chronic - therapy Kidney transplantation Male Medicaid Medical prognosis Medicare Middle Aged Multivariate analysis Patients Population studies Quality of life Regression analysis Renal Dialysis Renal replacement therapy Retrospective Studies Sepsis Stroke United States - epidemiology vascular access Vascular Patency Venous access Women |
| title | Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease |
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