Arteriovenous Fistula Maturation in Prevalent Hemodialysis Patients in the United States: A National Study.
Arteriovenous Fistula Maturation in Prevalent Hemodialysis Patients in the United States: A National Study.
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DOI：
10.1053/j.ajkd.2017.11.020
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Saran R
中科院分区：
文献类型：
--
作者：
Woodside KJ;Bell S;Mukhopadhyay P;Repeck KJ;Robinson IT;Eckard AR;Dasmunshi S;Plattner BW;Pearson J;Schaubel DE;Pisoni RL;Saran R
Arteriovenous fistulae (AVFs) are the preferred form of hemodialysis vascular access, but maturation failures occur frequently, often resulting in prolonged catheter use. We sought to characterize AVF maturation among a national sample of prevalent hemodialysis patients in the United States. Nonconcurrent observational cohort study. Prevalent hemodialysis patients having had at least one new AVF placed during 2013, as identified via Medicare claims data in the United States Renal Data System (USRDS). Demographics, geographic location, dialysis vintage, comorbidities. Successful maturation following placement defined by subsequent use identified using monthly CROWNWeb data. Rates of AVF maturation were compared across strata of predictors. Patients were followed until the earliest evidence of death, AVF maturation, or the end of 2014. In the study period, 45,087 new AVFs were placed in 39,820 prevalent hemodialysis patients. No evidence of use was identified for 36.2% of AVFs. Only 54.7% of AVFs were used within four months of placement, with maturation rates varying considerably across end-stage renal disease (ESRD) networks. Older age was associated with lower AVF maturation rates. Female sex, black race, some comorbidities (cardiovascular disease, peripheral artery disease, diabetes, needing assistance, or institutionalized status), dialysis vintage >1 year, and catheter or arteriovenous graft use at ESRD incidence were also associated with lower rates of successful AVF maturation. In contrast, hypertension and prior AVF placement at ESRD incidence were associated with higher rates of successful AVF maturation. This study relies on administrative data, with monthly recording of access use. We identified numerous associations between AVF maturation and patient-level factors in a recent national sample of United States hemodialysis patients. After accounting for these patient factors, we observed substantial differences in AVF maturation across some ESRD Networks—indicating a need for additional study of the provider, practice, and regional factors that explain AVF maturation.
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