MP661ARTERIOVENOUS FISTULA AND ARTERIOVENOUS GRAFT FOR VASCULAR ACCESS IN HAEMODIALYSIS - A RETROSPECTIVE COHORT STUDY

Introduction Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC). Methods Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations. Results FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, p<0.001) and DVA-related infections (0.16 vs. 0.20, p<0.001), fewer hospitalizations (1.65 vs. 1.91, p<0.001), and lower total per-member-per-month (PMPM) payments ($5042 vs. $5361, p<0.001) than HOPD patients. CMFOC patients had lower annual mortality (12.5% vs. 13.8%, p<0.001), PMPM payments (DVA services) ($1486 vs. $1533, p<0.001) and hospitalizations ($1752 vs. $1816, p<0.001) than AOFOC patients. Conclusions Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.

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Long-term prognosis of vascular access in hemodialysis patients with systemic lupus erythematosus: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-92005-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Fan-Yu Chen ◽

Chun-Fan Chen ◽

Ann Charis Tan ◽

Chia-Hao Chan ◽

Fu-An Chen ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cohort Study ◽

Vascular Access ◽

Lupus Erythematosus ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hemodialysis Patients ◽

Incidence Rates ◽

Systemic Lupus

AbstractPatients with systemic lupus erythematosus (SLE) have a higher risk of vascular complications. This retrospective cohort study aimed to analyze the differences in the risk of arteriovenous fistula or graft (AVF/AVG) dysfunction in hemodialysis patients with and without SLE from Taiwan’s National Health Insurance Database over a 10-year period. AVF/AVG dysfunction is defined as the occurrence of the first episode of intervention after vascular access creation. A total of 1366 HD patients with SLE had higher incidence rates of AVF/AVG dysfunction than 4098 non-SLE HD patients in the following 4 periods: (1) after 1 year (incidence rates = 15.21% and 13.01%, respectively; subdistribution hazard ratio (SHR) = 1.16; P = 0.007), (2) 1st-to-10th-year period (15.36% and 13.25%; SHR = 1.16; P = 0.007), (3) 5th-to-10th-year period (11.91% and 8.1%; SHR = 1.42; P = 0.003), and (4) overall period (23.53% and 21.66%; SHR = 1.09; P = 0.027). In conclusion, there were significantly higher incidence rates of AVF/AVG dysfunction in SLE patients during the long-term follow-up period. Vascular access function should be monitored regularly by clinical examinations, especially after 1 year and during 5 to 10 years, to improve AVF/AVG patency and dialysis adequacy in SLE patients undergoing maintenance hemodialysis.

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Surgeon Characteristics and Dialysis Vascular Access Outcomes in the United States: A Retrospective Cohort Study

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2019.08.001 ◽

2020 ◽

Vol 75 (2) ◽

pp. 158-166 ◽

Cited By ~ 6

Author(s):

Vahakn B. Shahinian ◽

Xiaosong Zhang ◽

Anca M. Tilea ◽

Kevin He ◽

Douglas E. Schaubel ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

Vascular Access ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The United States

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Durability of percutaneous transluminal angioplasty for failing hemodialysis vascular access, retrospective cohort study

International Journal of Surgery Open ◽

10.1016/j.ijso.2020.05.006 ◽

2020 ◽

Vol 24 ◽

pp. 185-188

Author(s):

Abdullah Alhaizaey ◽

Musaad Alghamdi ◽

Ahmed Azazy ◽

Walid Omran ◽

Mohammed Hamdy ◽

...

Keyword(s):

Cohort Study ◽

Vascular Access ◽

Retrospective Cohort Study ◽

Percutaneous Transluminal Angioplasty ◽

Retrospective Cohort ◽

Transluminal Angioplasty ◽

Hemodialysis Vascular Access ◽

Percutaneous Transluminal

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Outbreak of Hemodialysis Vascular Access Site Infections Related to Malfunctioning Permanent Tunneled Catheters: Making the Case for Active Infection Surveillance

Infection Control and Hospital Epidemiology ◽

10.1086/502103 ◽

2002 ◽

Vol 23 (9) ◽

pp. 538-541 ◽

Cited By ~ 26

Author(s):

Elizabeth L. Hannah ◽

Kurt B. Stevenson ◽

Connie A. Lowder ◽

Michael J. Adcox ◽

Robert L. Davidson ◽

...

Keyword(s):

Cohort Study ◽

Infection Rate ◽

Vascular Access ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Infectious Complications ◽

Routine Activity ◽

Access Site ◽

Integrated Network ◽

Infection Surveillance

Objective:To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.Design:The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1,1999, and March 31, 2000.Setting:Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.Patients:Outpatients receiving long-term hemodialysis.Results:During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning “Brand A” catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).Conclusions:Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.

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