Vascular access use in Europe and the United States: Results from the DOPPS

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

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Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome

Gender Medicine ◽

10.1016/s1550-8579(07)80040-4 ◽

2007 ◽

Vol 4 (3) ◽

pp. 193-204 ◽

Cited By ~ 28

Author(s):

Richard J. Marcus ◽

Dawn A. Marcus ◽

Kalathil K. Sureshkumar ◽

Sabiha M. Hussain ◽

Rita L. McGill

Keyword(s):

United States ◽

Gender Differences ◽

Vascular Access ◽

The United States ◽

Hemodialysis Patients ◽

Developing Strategies

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Supply and Distribution of Vascular Access Physicians in the United States: A Cross-Sectional Study

Kidney360 ◽

10.34067/kid.0002722020 ◽

2020 ◽

Vol 1 (8) ◽

pp. 763-771

Author(s):

Shoou-Yih D. Lee ◽

Jie Xiang ◽

Abhijit V. Kshirsagar ◽

Diane Steffick ◽

Rajiv Saran ◽

...

Keyword(s):

United States ◽

Vascular Access ◽

Primary Care Physicians ◽

The United States ◽

Cross Sectional Study ◽

Bivariate Analysis ◽

Health Resource ◽

Surgical Specialty ◽

Cross Sectional ◽

Hospital Referral

BackgroundBecause functioning permanent vascular access (arteriovenous fistula [AVF] or arteriovenous graft [AVG]) is crucial for optimizing patient outcomes for those on hemodialysis, the supply of physicians placing vascular access is key. We investigated whether area-level demographic and healthcare market attributes were associated with the distribution and supply of AVF/AVG access physicians in the United States.MethodsA nationwide registry of physicians placing AVFs/AVGs in 2015 was created using data from the United States Renal Data System and the American Physician Association’s Physician Masterfile. We linked the registry information to the Area Health Resource File to assess the supply of AVF/AVG access physicians and their professional attributes by hospital referral region (HRR). Bivariate analysis and Poisson regression were performed to examine the relationship between AVF/AVG access physician supply and demographic, socioeconomic, and health resource conditions of HRRs. The setting included all 50 states. The main outcome was supply of AVF/AVG access physicians, defined as the number of physicians performing AVF and/or AVG placement per 1000 prevalent patients with ESKD.ResultsThe majority of vascular access physicians were aged 45–64 (average age, 51.6), male (91%), trained in the United States (76%), and registered in a surgical specialty (74%). The supply of physicians varied substantially across HRRs. The supply was higher in HRRs with a higher percentage white population (β=0.44; SEM=0.14; P=0.002), lower unemployment rates (β=−10.74; SEM=3.41; P=0.002), and greater supply of primary care physicians (β=0.18; SEM=0.05; P=0.001) and nephrologists (β=15.89; SEM=1.22; P<0.001).ConclusionsGeographic variation was observed in the supply of vascular access physicians. Higher supply of such specialist physicians in socially and economically advantaged areas may explain disparities in vascular access and outcomes in the United States and should be the subject of further study and improvement.

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Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2021.01.019 ◽

2021 ◽

Author(s):

Kenneth J. Woodside ◽

Kaitlyn J. Repeck ◽

Purna Mukhopadhyay ◽

Douglas E. Schaubel ◽

Vahakn B. Shahinian ◽

...

Keyword(s):

United States ◽

Vascular Access ◽

The United States ◽

Hemodialysis Patients

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Retrospective Analysis of a Pediatric Vascular Access Program and Clinical Outcomes

Journal of the Association for Vascular Access ◽

10.1016/j.java.2013.04.001 ◽

2013 ◽

Vol 18 (2) ◽

pp. 114-120 ◽

Cited By ~ 1

Author(s):

Stephanie Pitts

Keyword(s):

United States ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Vascular Access ◽

The United States ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Children's Hospitals ◽

The Past ◽

Children’S Hospitals

Abstract Background: The specialty of pediatric vascular access has grown rapidly during the past 5 years across the United States. The majority of children's hospitals have nurse-led vascular access teams that are providing comprehensive services, including the placement of peripherally inserted central catheters. A children's hospital in the southeastern United States conducted an Internal Review Board approved, retrospective analysis of 669 patients who had a peripherally inserted central catheter placed. Objective: The objective was to have a better understanding of the program and clinical outcomes as well as identify areas for improvement. Methods: A data collection tool was developed to review the medical records of patients receiving a peripherally inserted central catheter from January 2009 through June 2011. Variables of interest included patient age, admitting diagnosis, intended therapy, procedure location, sedation type and usage, procedure success, insertion attempts, vessel selected, catheter size and type, catheter tip location, reason for discontinuation, and infection. The data was collected and analyzed by a nurse researcher from the University of South Florida. Results: Using the Modified Seldinger Technique and ultrasound, the team inserted a full line of polyurethane catheters, including computed tomography-injectable catheters, with an insertion success rate of 94%. We identified a significant reduction in our hospital's infection rate—from 9.12 per 1,000 catheter line days to 2.0 per 1,000 catheter line days—during the first year and a half of the program. The use of sedation and anesthesia was significantly reduced, with 49% of patients receiving an oral anxiolytic dose of midazolam and the integration of certified child life specialists into the procedure. Conclusions: Pediatric vascular access is a rapidly growing specialty in nursing. Nurse-led vascular access teams have become commonplace in children's hospitals throughout the United States. Although the specialty has grown rapidly during the past 5 years, there is a need for data sharing to contribute to the knowledge base of pediatric vascular access.

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