The Rate of Procedures Required to Maintain Hemodialysis Vascular Access: A Data Linkage Analysis

Area of Science:

• Nephrology
• Vascular Surgery
• Health Services Research

Background:

• Maintaining hemodialysis vascular access is crucial for patients and clinicians.
• Limited population data on procedural events hinders understanding of vascular access maintenance frequency.

Purpose of the Study:

• To determine the incidence and associated factors of vascular access procedures in hemodialysis patients.
• To analyze procedural rates in relation to patient demographics, clinical variables, and treatment characteristics.

Main Methods:

• National linkage analysis of registry and administrative health data in New Zealand (2004-2021).
• Included patients starting kidney replacement therapy, analyzing data from two years prior to two years after hemodialysis commencement.
• Calculated incidence rates per patient-year and used multivariate flexible parametric models to assess associations.

Main Results:

• Average rate of 0.71 procedures per patient-year (N=7725), with a median of 2 procedures.
• Higher procedural hazard observed in females (aHR 1.09) and individuals with BMI >35 kg/m2 (aHR 1.17).
• Lower procedural hazard in more recent treatment periods (2017-2021 vs. 2002-2006) and higher hazard with primary central venous catheter use (aHR 1.34).

Conclusions:

• Approximately half of adult patients undergo two or fewer vascular access procedures around hemodialysis initiation.
• Procedural rates are influenced by sex, body mass index, treatment period, and treatment center.
• Primary central venous catheters are associated with a significantly increased hazard of procedures compared to arteriovenous fistulas or grafts.