Dr Kate Richards1,2, Prof Kevan Polkinghorne3,4,5, Dr David McGregor1,2, A/Prof Rachael Walker6, Dr Curtis Walker7, Dr Jonathan Williman8, Prof Suetonia Green1,2
1University Of Otago Christchurch, Christchurch, New Zealand, 2Department of Nephrology, Te Whatu Ora Health New Zealand, Waitaha Canterbury, Christchurch, New Zealand, 3Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Australia, 4Department of Medicine, Monash University, Melbourne, Australia, 5School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia, 6Faculty of Medical and Health Sciences, Nursing, University of Auckland, Auckland, New Zealand, 7Department of Nephrology, Te Whatu Ora Health New Zealand Te Pae Hauora o Ruahine o Tararua Midcentral, Palmerston North, New Zealand, 8Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
Biography:
Kate Richards is a Nephrologist based in Christchurch, currently undertaking a PhD in haemodialysis vascular access.
Abstract:
Rationale & Objective:
The rate of procedures required to maintain hemodialysis vascular access is considered a critical clinical outcome. Existing evidence is limited as vascular access procedures are not recorded in many large datasets. We estimated the rate of vascular access procedures and the association between baseline characteristics and procedural hazards.
Study Design:
Retrospective cohort linking registry and hospitalization data, including adult patients who underwent primary hemodialysis vascular access formation from 2004–2021.
Outcomes:
The rate and associations with vascular access related procedures.
Results:
In 7,725 patients the average rate of vascular access procedures was 0.71 (95% CI 0.70–0.72) procedures per patient-year, median 2 (quartiles 1,3) procedures. The hazard of procedures associated with sex (adjusted hazard ratio (HR) female versus male 1.09; 95% CI 1.05, 1.13) and body mass index (HR 1.17; 95% CI 1.10, 1.24 BMI>35 kg/m2 versus 18.5–24.9). Patients treated in most recent treatment periods experienced a lower procedural hazard (HR 0.77; 95% CI 0.73-1.05 in 2017–2021 compared to 2002–2006), and the hazard varied among treating centers. Primary central venous catheter was associated with an increased procedural hazard (HR 1.34, 95% CI 1.28, 1.40) compared to primary arteriovenous fistula or graft.
Limitations:
Missing data for central venous catheter procedures.
Conclusions:
Half the cohort underwent two or fewer vascular access procedures. Procedural rates differed by sex, body mass, treatment period and treatment center and were higher for adults commencing hemodialysis with a central venous catheter