The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter

Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We iden...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2017-12, Vol.28 (12), p.3679-3687
Main Authors: Al-Balas, Alian, Lee, Timmy, Young, Carlton J, Kepes, Jeffrey A, Barker-Finkel, Jill, Allon, Michael
Format: Article
Language:English
Subjects:
Adult
Aged
Arteriovenous Fistula
Arteriovenous Shunt, Surgical - adverse effects
Blood Vessels - transplantation
Catheterization, Central Venous - adverse effects
Catheterization, Central Venous - economics
Catheters, Indwelling - adverse effects
Clinical Research
Comorbidity
Female
Follow-Up Studies
Health Care Costs
Humans
Kidney Failure, Chronic - etiology
Male
Middle Aged
Renal Dialysis - adverse effects
Renal Dialysis - economics
Renal Dialysis - methods
Retrospective Studies
Treatment Outcome
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Summary:Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We identified 479 patients starting hemodialysis with a CVC at a large medical center (during 2004-2012) who subsequently had an AVF ( =295) or AVG ( =105) placed or no arteriovenous access (CVC group, =71). Compared with patients receiving an AVG, those receiving an AVF had more frequent surgical access procedures per year (1.01 [95% confidence interval, 0.95 to 1.08] versus 0.62 [95% confidence interval, 0.55 to 0.70];
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2016060707