Supplementary Material for: Vascular Access Placement Order and Outcomes in Hemodialysis Patients: A Longitudinal Study
Murea M.
Brown W.M.
Divers J.
Moossavi S.
Robinson T.W.
Bagwell B.
Burkart J.M.
Freedman B.I.
10.6084/m9.figshare.5422636.v1
https://karger.figshare.com/articles/journal_contribution/Supplementary_Material_for_Vascular_Access_Placement_Order_and_Outcomes_in_Hemodialysis_Patients_A_Longitudinal_Study/5422636
<p><b><i>Background: </i></b>Arteriovenous accesses (AVA) in patients
performing hemodialysis (HD) are labeled “permanent” for AV fistulas
(AVF) or grafts (AVG) and “temporary” for tunneled central venous
catheters (TCVC). Durability and outcomes of permanent vascular accesses
based on the sequence in which they were placed or used receives little
attention. This study analyzed longitudinal transitions between
TCVC-based and AVA-based HD outcomes according to the order of
placement. <b><i>Methods:</i></b> All 391 patients initiating chronic HD
via a TCVC between 2012 and 2013 at 12 outpatient academic dialysis
units were included in this study. Chronological distributions of HD
vascular accesses were recorded over a mean (SD) of 2.8 (0.9) years and
sequentially grouped into periods for TCVC-delivered and AVA-delivered
(AVF or AVG) HD. Primary AVA failure and cumulative access survival were
evaluated based on access placement sequence and type, adjusting for
age. <b><i>Results: </i></b>In total, 92.3% (361/391) of patients
underwent 497 AVA placement surgeries. Analyzing the initial 3
surgeries, primary AVF failure rates increased with each successive
fistula placement (<i>p</i> = 0.008). Among the 82.9% (324/391) of TCVC
patients successfully converted to an AVA, 30.9% returned to a TCVC,
followed by a 58.0% conversion rate to another AVA. Annual per-patient
vascular access transition rates were 2.02 (0.09) HD periods using a
TCVC and 0.54 (0.03) HD periods using an AVA. Comparing the first AVA
used with the second, cumulative access survivals were 701.0 (370.0) vs.
426.5 (275.0) days, respectively. Excluding those never converting to
an AVF or AVG, 169 (52.2%) subsequently converted from a TCVC to a
permanent access and received HD via AVA for ≥80% of treatments. <b><i>Conclusions: </i></b>HD
vascular access outcomes differ based on the sequence of placement. In
spite of frequent AVA placements, only half of patients effectively
achieved a “permanent” vascular access and used an AVA for the majority
of HD treatments.</p>
2017-09-20 08:59:40
Access
Arteriovenous fistula
Arteriovenous graft
End-stage kidney disease
Hemodialysis
Tunneled catheter