Instalaciones de Hemodiálisis, Cirujanos de Acceso Vascular y Uso de Catéter Venoso Central: Un Estudio de Cohorte...

Reducing central venous catheter usage for hemodialysis among patients with kidney failure receiving maintenance hemodialysis is an important priority. Previous reports have suggested that partnerships between hemodialysis facilities and vascular access surgeons lead to reduced rates of central venous catheter use. We studied whether a greater intensity of these relationships was associated with less use of central venous catheters.

National retrospective cohort study.

109,293 patients with kidney failure receiving maintenance hemodialysis within 4,402 facilities.

Facility-level Herfindahl-Hirschman Index, an established measure of market concentration used as a proxy for closeness of the relationship between hemodialysis facilities and vascular access surgeons, with higher indices suggesting closer relationships.

Greater than 90 days of continuous central venous catheter use for hemodialysis in 2018.

Mixed effects logistic regression model including patient-level covariates, facility-level covariates, and facility random effects. Dialysis facilities were divided into quartiles based on increasing Herfindahl-Hirschman Index. Multiple sensitivity analyses were conducted using similar models.

Patients in facilities in the highest Herfindahl-Hirschman Index quartile were less likely to have continued catheter use for more than 90 days than those in the lowest quartile (odds ratio, 0.80; 95% confidence interval, 0.75 to 0.87; p <0.001). This association was also observed in multiple sensitivity analyses.

Misclassification of the exposure; inclusion of patients insured by Medicare Fee-for-Service; unmeasured confounding.

More extensive partnerships between dialysis facilities and vascular access surgeons reflected by the Herfindahl-Hirschman Index were associated with lower rates of central venous catheter use for hemodialysis.