Early Kidney Transplantation or Conversion to Peritoneal Dialysis after First-Time Arteriovenous Access Creation

Area of Science:

• Nephrology
• Vascular Surgery
• Public Health

Background:

• Autogenous arteriovenous (AV) access is created for end-stage renal disease (ESRD) patients initiating hemodialysis (HD).
• Patients may continue HD, receive a kidney transplant, or switch to peritoneal dialysis (PD).
• Identifying factors influencing early modality transition is crucial for patient care.

Purpose of the Study:

• To identify patient-specific factors associated with early transition from HD to kidney transplantation or PD after AV access creation.
• To analyze the relationship between demographics, comorbidities, social disadvantage, and functional status with renal replacement therapy modality.

Main Methods:

• A case-control study utilizing the Vascular Quality Initiative (2011-2022) database.
• Included patients with first-time AV access creation and long-term follow-up.
• Compared patients remaining on HD (control) with those receiving early kidney transplant or converting to PD (cases).

Main Results:

• 19,782 patients analyzed; 1.3% received kidney transplants, 2.3% converted to PD.
• Black race, noncommercial insurance, and certain comorbidities were linked to decreased kidney transplantation.
• Conversion to PD was associated with higher area deprivation index (ADI) quintiles.

Conclusions:

• Disparities in kidney transplantation access exist, influenced by race and insurance, extending beyond community-level factors.
• Early kidney transplantation demonstrated a significant 3-year survival advantage compared to HD and PD.
• Further efforts are needed to enhance access to kidney transplantation and PD for ESRD patients.