Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States
As the proportion of arteriovenous fistulas (AVFs) compared with arteriovenous grafts (AVGs) in the United States has increased, there has been a concurrent increase in interventions. We explored AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis. Observationa...
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| Veröffentlicht in: | American journal of kidney diseases 2021-09, Vol.78 (3), p.369-379.e1 |
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| container_title | American journal of kidney diseases |
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| creator | Woodside, Kenneth J. Repeck, Kaitlyn J. Mukhopadhyay, Purna Schaubel, Douglas E. Shahinian, Vahakn B. Saran, Rajiv Pisoni, Ronald L. |
| description | As the proportion of arteriovenous fistulas (AVFs) compared with arteriovenous grafts (AVGs) in the United States has increased, there has been a concurrent increase in interventions. We explored AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis.
Observational cohort study.
Patients initiating hemodialysis from July 1, 2012, to December 31, 2014, and having a first-time AVF or AVG placement between dialysis initiation and 1 year (N = 73,027), identified using the US Renal Data System (USRDS).
Patient characteristics.
Successful AVF/AVG use and intervention procedure burden.
For each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modeling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.
During the maturation phase, 13,989 of 57,275 patients (24.4%) in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person. In the AVG group 2,904 of 15,572 patients (18.4%) required intervention during maturation, with therapeutic interventional requirements of 0.28 per person. During the maintenance phase, in the AVF group 12,732 of 32,115 patients (39.6%) required intervention, with a therapeutic intervention rate of 0.93 per person-year. During maintenance phase, in the AVG group 5,928 of 10,271 patients (57.7%) required intervention, with a therapeutic intervention rate of 1.87 per person-year. For both phases, the intervention rates for AVF tended to be higher on the East Coast while those for AVG were more uniform geographically.
This study relies on administrative data, with monthly recording of access use.
During maturation, interventions for both AVFs and AVGs were relatively common. Once successfully matured, AVFs had lower maintenance interventional requirements. During the maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.
[Display omitted] |
| doi_str_mv | 10.1053/j.ajkd.2021.01.019 |
| format | Article |
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Observational cohort study.
Patients initiating hemodialysis from July 1, 2012, to December 31, 2014, and having a first-time AVF or AVG placement between dialysis initiation and 1 year (N = 73,027), identified using the US Renal Data System (USRDS).
Patient characteristics.
Successful AVF/AVG use and intervention procedure burden.
For each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modeling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.
During the maturation phase, 13,989 of 57,275 patients (24.4%) in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person. In the AVG group 2,904 of 15,572 patients (18.4%) required intervention during maturation, with therapeutic interventional requirements of 0.28 per person. During the maintenance phase, in the AVF group 12,732 of 32,115 patients (39.6%) required intervention, with a therapeutic intervention rate of 0.93 per person-year. During maintenance phase, in the AVG group 5,928 of 10,271 patients (57.7%) required intervention, with a therapeutic intervention rate of 1.87 per person-year. For both phases, the intervention rates for AVF tended to be higher on the East Coast while those for AVG were more uniform geographically.
This study relies on administrative data, with monthly recording of access use.
During maturation, interventions for both AVFs and AVGs were relatively common. Once successfully matured, AVFs had lower maintenance interventional requirements. During the maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.
[Display omitted]</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2021.01.019</identifier><identifier>PMID: 33857533</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Angioplasty ; arteriovenous fistula (AVF) ; arteriovenous graft (AVG) ; assisted maturation ; dialysis access ; end-stage renal disease (ESRD) ; endovascular interventions ; hemodialysis (HD) ; patency ; regional procedure variation ; thrombectomy ; US Renal Data System (USRDS) ; vascular access</subject><ispartof>American journal of kidney diseases, 2021-09, Vol.78 (3), p.369-379.e1</ispartof><rights>2021 National Kidney Foundation, Inc.</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-79393cc72e82d9215b6393c2625433fe1fd76d5e66fe785ddeaf986440dce9f33</citedby><cites>FETCH-LOGICAL-c455t-79393cc72e82d9215b6393c2625433fe1fd76d5e66fe785ddeaf986440dce9f33</cites><orcidid>0000-0002-7495-3758</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638621005114$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33857533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Woodside, Kenneth J.</creatorcontrib><creatorcontrib>Repeck, Kaitlyn J.</creatorcontrib><creatorcontrib>Mukhopadhyay, Purna</creatorcontrib><creatorcontrib>Schaubel, Douglas E.</creatorcontrib><creatorcontrib>Shahinian, Vahakn B.</creatorcontrib><creatorcontrib>Saran, Rajiv</creatorcontrib><creatorcontrib>Pisoni, Ronald L.</creatorcontrib><title>Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>As the proportion of arteriovenous fistulas (AVFs) compared with arteriovenous grafts (AVGs) in the United States has increased, there has been a concurrent increase in interventions. We explored AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis.
Observational cohort study.
Patients initiating hemodialysis from July 1, 2012, to December 31, 2014, and having a first-time AVF or AVG placement between dialysis initiation and 1 year (N = 73,027), identified using the US Renal Data System (USRDS).
Patient characteristics.
Successful AVF/AVG use and intervention procedure burden.
For each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modeling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.
During the maturation phase, 13,989 of 57,275 patients (24.4%) in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person. In the AVG group 2,904 of 15,572 patients (18.4%) required intervention during maturation, with therapeutic interventional requirements of 0.28 per person. During the maintenance phase, in the AVF group 12,732 of 32,115 patients (39.6%) required intervention, with a therapeutic intervention rate of 0.93 per person-year. During maintenance phase, in the AVG group 5,928 of 10,271 patients (57.7%) required intervention, with a therapeutic intervention rate of 1.87 per person-year. For both phases, the intervention rates for AVF tended to be higher on the East Coast while those for AVG were more uniform geographically.
This study relies on administrative data, with monthly recording of access use.
During maturation, interventions for both AVFs and AVGs were relatively common. Once successfully matured, AVFs had lower maintenance interventional requirements. During the maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.
[Display omitted]</description><subject>Angioplasty</subject><subject>arteriovenous fistula (AVF)</subject><subject>arteriovenous graft (AVG)</subject><subject>assisted maturation</subject><subject>dialysis access</subject><subject>end-stage renal disease (ESRD)</subject><subject>endovascular interventions</subject><subject>hemodialysis (HD)</subject><subject>patency</subject><subject>regional procedure variation</subject><subject>thrombectomy</subject><subject>US Renal Data System (USRDS)</subject><subject>vascular access</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc9qHSEUxiW0JDdpX6CL4rKbuXV0dEYohdvQ_IFAQ9J0K0bPJN7OaKrOhez6DnnDPEkcbhraTeGAePzOz8P3IfSuJsuacPZxvdTrn3ZJCa2XZC65gxY1p6wSHeteoQWhLa0E68Qe2k9pTQiRTIhdtMdYx1vO2AKlVcwQXdiAD1PCP3Qy06AjXhkDKT3-friAQWew-DwGA3aKesBfpmjB49UY_A0-9caVW8YnMAbr9HCfXMLnOrvSTNh5nG8BX3k3Qy5zYaU36HWvhwRvn88DdHX09fvhSXX27fj0cHVWmYbzXLWSSWZMS6GjVtKaX4u5QQXlDWM91L1theUgRA9tx60F3ctONA2xBmTP2AH6vOXeTdcjlKbPZX11F92o470K2ql_X7y7VTdho4p7jRCiAD48A2L4NUHKanTJwDBoD8UtRXndcEkZlUVKt1ITQ0oR-pdvaqLmtNRazWmpOS1F5pqH3v-94MvIn3iK4NNWAMWmjYOokim-liBcBJOVDe5__CeoyqoC</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Woodside, Kenneth J.</creator><creator>Repeck, Kaitlyn J.</creator><creator>Mukhopadhyay, Purna</creator><creator>Schaubel, Douglas E.</creator><creator>Shahinian, Vahakn B.</creator><creator>Saran, Rajiv</creator><creator>Pisoni, Ronald L.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7495-3758</orcidid></search><sort><creationdate>20210901</creationdate><title>Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States</title><author>Woodside, Kenneth J. ; Repeck, Kaitlyn J. ; Mukhopadhyay, Purna ; Schaubel, Douglas E. ; Shahinian, Vahakn B. ; Saran, Rajiv ; Pisoni, Ronald L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-79393cc72e82d9215b6393c2625433fe1fd76d5e66fe785ddeaf986440dce9f33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Angioplasty</topic><topic>arteriovenous fistula (AVF)</topic><topic>arteriovenous graft (AVG)</topic><topic>assisted maturation</topic><topic>dialysis access</topic><topic>end-stage renal disease (ESRD)</topic><topic>endovascular interventions</topic><topic>hemodialysis (HD)</topic><topic>patency</topic><topic>regional procedure variation</topic><topic>thrombectomy</topic><topic>US Renal Data System (USRDS)</topic><topic>vascular access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Woodside, Kenneth J.</creatorcontrib><creatorcontrib>Repeck, Kaitlyn J.</creatorcontrib><creatorcontrib>Mukhopadhyay, Purna</creatorcontrib><creatorcontrib>Schaubel, Douglas E.</creatorcontrib><creatorcontrib>Shahinian, Vahakn B.</creatorcontrib><creatorcontrib>Saran, Rajiv</creatorcontrib><creatorcontrib>Pisoni, Ronald L.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Woodside, Kenneth J.</au><au>Repeck, Kaitlyn J.</au><au>Mukhopadhyay, Purna</au><au>Schaubel, Douglas E.</au><au>Shahinian, Vahakn B.</au><au>Saran, Rajiv</au><au>Pisoni, Ronald L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>78</volume><issue>3</issue><spage>369</spage><epage>379.e1</epage><pages>369-379.e1</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>As the proportion of arteriovenous fistulas (AVFs) compared with arteriovenous grafts (AVGs) in the United States has increased, there has been a concurrent increase in interventions. We explored AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis.
Observational cohort study.
Patients initiating hemodialysis from July 1, 2012, to December 31, 2014, and having a first-time AVF or AVG placement between dialysis initiation and 1 year (N = 73,027), identified using the US Renal Data System (USRDS).
Patient characteristics.
Successful AVF/AVG use and intervention procedure burden.
For each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modeling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.
During the maturation phase, 13,989 of 57,275 patients (24.4%) in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person. In the AVG group 2,904 of 15,572 patients (18.4%) required intervention during maturation, with therapeutic interventional requirements of 0.28 per person. During the maintenance phase, in the AVF group 12,732 of 32,115 patients (39.6%) required intervention, with a therapeutic intervention rate of 0.93 per person-year. During maintenance phase, in the AVG group 5,928 of 10,271 patients (57.7%) required intervention, with a therapeutic intervention rate of 1.87 per person-year. For both phases, the intervention rates for AVF tended to be higher on the East Coast while those for AVG were more uniform geographically.
This study relies on administrative data, with monthly recording of access use.
During maturation, interventions for both AVFs and AVGs were relatively common. Once successfully matured, AVFs had lower maintenance interventional requirements. During the maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33857533</pmid><doi>10.1053/j.ajkd.2021.01.019</doi><orcidid>https://orcid.org/0000-0002-7495-3758</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0272-6386 |
| ispartof | American journal of kidney diseases, 2021-09, Vol.78 (3), p.369-379.e1 |
| issn | 0272-6386 1523-6838 |
| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | Angioplasty arteriovenous fistula (AVF) arteriovenous graft (AVG) assisted maturation dialysis access end-stage renal disease (ESRD) endovascular interventions hemodialysis (HD) patency regional procedure variation thrombectomy US Renal Data System (USRDS) vascular access |
| title | Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States |
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