Article Figures & Data
Figures
- Figure 1.
Flowsheet of patients included in the analysis, including initial vascular access placed, patient events during follow-up, and vascular access in use at the end of patient follow-up. fxn, function; HD, hemodialysis; PD, peritoneal dialysis.
- Figure 2.
Patients initiating hemodialysis with a CVC frequently require multiple AVF and AVG placements during follow-up.
- Figure 3.
The annual cost is higher in patients who initially receive an AVF rather than an AVG in multiple patient sub-groups. *P<0.05; **P<0.01 for AVG versus AVF. CHF, congestive heart failure; DM, diabetes mellitus.
Tables
- Table 1.
Comparison of baseline demographics of patients with an initial AVF surgery, AVG surgery, or no access surgery
Parameter AVF AVG CVC P Value No of patients 295 113 71 Age in yr, mean±SD 52±14 54±14 56±16 0.05 Age ≥65 yr, n (%) 53 (18) 27 (24) 20 (28) 0.11 Men, n (%) 178 (60) 43 (38) 31 (44) <0.001 Black, n (%) 260 (88) 98 (87) 61 (86) 0.85 Diabetes, n (%) 145 (49) 67 (59) 36 (51) 0.18 Hypertension, n (%) 281 (95) 108 (96) 70 (98) 0.44 Coronary artery disease, n (%) 66 (22) 26 (23) 23 (32) 0.20 Heart failure, n (%) 81 (27) 32 (28) 23 (32) 0.26 Cerebrovascular disease, n (%) 40 (14) 17 (15) 7 (10) 0.71 Peripheral vascular disease, n (%) 31 (10) 16 (14) 8 (11) 0.58 - Table 2.
Comparison of annual frequency of vascular access procedures and CRB between patents with an initial AVF surgery, AVG surgery, or no access surgery
Parameter AVF AVG CVC P Value P Value AVF versus AVG AVF versus CVC No. of patients 295 113 71 CVC exchange, n per patient-yr (95% CI) 0.49 (0.44 to 0.53) 0.50 (0.44 to 0.57) 3.55 (3.09 to 4.07) 0.19 <0.001 Angioplasty, n per patient-yr (95% CI) 0.63 (0.58 to 0.68) 0.58 (0.52 to 0.66) – 0.68 – Thrombectomy, n per patient-yr (95% CI) 0.35 (0.31 to 0.38) 0.52 (0.45 to 0.59) – 0.004 – All percutaneous procedures, n per patient-yr (95% CI) 1.46 (1.39 to 1.54) 1.61 (1.49 to 1.73) 3.55 (3.09 to 4.07) 0.06 0.002 Surgical access revisions, n per patient-yr (95% CI) 0.42 (0.38 to 0.47) 0.19 (0.15 to 0.24) – <0.001 – Access creations, n per patient-yr (95% CI) 0.59 (0.54 to 0.64) 0.43 (0.37 to 0.49) – <0.001 – All surgical procedures, n per patient-yr (95% CI) 1.01 (0.95 to 1.08) 0.62 (0.55 to 0.70) – <0.001 – All access procedures, n per patient-yr (95% CI) 2.48 (2.38 to 2.58) 2.23 (2.09 to 2.37) – 0.69 – CRBs, n per patient-yr (95% CI) 0.60 (0.55 to 0.65) 0.60 (0.53 to 0.68) 4.63 (4.09 to 5.21) 0.23 <0.001 Hospitalizations for CRB, n per patient-yr (95% CI) 0.24 (0.22 to 0.28) 0.18 (0.14 to 0.22) 2.06 (1.71 to 2.46) 0.32 <0.001 The frequency of access events or procedures between subgroups (AVF versus AVG, AVF versus CVC, and failed versus successful AVFs) was assessed using negative binomial models to account for the relatively high number of patients with zero counts. 95% CI, 95% confidence interval.
- Table 3.
Median annual vascular access-related costs in patients with an initial AVF, an initial AVG, or no access surgery
Parameter AVF AVG CVC P Value, AVG versus AVF P Value, CVC versus AVF No. of patients 295 113 71 Percutaneous procedures, median $/yr [IQR] 1879 [371–4290] 2438 [444–4593] 3860 [1586–7759] 0.28 <0.001 Surgical access procedures, median $/yr [IQR] 4857 [2523–8835] 2819 [1411–4274] – <0.001 – Hospitalization for CRB, median $/yr [IQR] 0 [0–6345] 0 [0–7171] 26,709 [9746–56,794] 0.13 <0.001 Total access-related cost, median $/yr [IQR] 10,642 [5406–19,878] 6810 [3718–13,651] 28,709 [11,793–66,917] 0.001 <0.001 - Table 4.
Cost of access-related procedures in patients with an initial AVG, a successful AVF, or a failed AVF
Parameter AVG AVF-S AVF-F P Value P Value AVF-S versus AVG AVF-F versus AVF-S No. of patients 113 190 105 Percutaneous procedures, median $/yr [IQR] 2438 [444–4593] 1438 [0–3527] 2892 [1277–5518] <0.01 <0.001 Surgical access procedures, median $/yr [IQR] 2819 [1411–4274] 4675 [2277–8234] 5501 [2948–10,281] <0.001 0.03 Hospitalization for CRB, median $/yr [IQR] 0 [0–7171] 0 [0–2020] 5693 [1908–16,361] 0.06 <0.001 Total access-related cost, median $/yr [IQR] 6810 [3718–13,651] 8146 [4014–14,397] 16,652 [9938–33,053] 0.46 <0.001 AVF-S, successful arteriovenous fistula; AVF-F, failed arteriovenous fistula.
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