Vascular access creation before hemodialysis initiation and use: a population-based cohort study

Area of Science:

• Nephrology
• Vascular Surgery
• Public Health

Background:

• Guideline recommendations promote timely arteriovenous access (AV access) creation for hemodialysis.
• However, only 17% of Canadian patients use AV access at hemodialysis initiation, suggesting a gap between recommendations and practice.

Purpose of the Study:

• To estimate the proportion of patients with pre-hemodialysis AV access creation and use.
• To examine trends in AV access creation over time.
• To identify factors influencing AV access creation, including nephrology referral timing and patient characteristics.

Main Methods:

• A population-based cohort study of 17,183 adult patients initiating hemodialysis in Ontario, Canada (2001-2010).
• Analysis of large healthcare databases to determine AV access creation before and use at hemodialysis start.
• Statistical modeling to assess the impact of late nephrology referral and patient demographics on AV access creation.

Main Results:

• Only 27% of incident hemodialysis patients had AV access created, with a median of 184 days between creation and initiation.
• AV access creation rates before hemodialysis initiation declined since 2001.
• Late nephrology referral, female sex, comorbidities, and rural residence were associated with lower AV access creation rates.

Conclusions:

• AV access creation prior to hemodialysis initiation remains low in Canada, even for patients under nephrologist care.
• Further research is needed to identify and address barriers to AV access creation to improve adherence to clinical guidelines and patient outcomes.