Table 1 Pre-operative demographic and clinical characteristics of patients undergoing arteriovenous access creation with and without 1-year successful clinical use of the index access for hemodialysis
Index access not used for hemodialysis (abandoned) at 1-year of follow-up (n = 31,370) | Successful clinical use of the index access for hemodialysis at 1-year of follow-up (n = 28,304) | P | |
|---|---|---|---|
Demographics | |||
Age, years, mean (SD) | 62.6 (14.6) | 61.2 (14.7) | < 0.001 |
Female | 14,228 (45.4) | 11,853 (41.9) | < 0.001 |
BMI, kg/m2, mean (SD) | 30.4 (8.4) | 29.7 (7.8) | < 0.001 |
Race | |||
American Indian or Alaskan Native | 383 (1.2) | 416 (1.5) | < 0.001 |
Asian | 871 (2.8) | 1,078 (3.8) | |
Black | 10,319 (32.9) | 10,379 (36.7) | |
Native Hawaiian or other Pacific Islander | 136 (0.4) | 130 (0.5) | |
White | 17,329 (55.2) | 13,996 (49.4) | |
More than 1 race | 173 (0.6) | 175 (0.6) | |
Unknown/other | 2159 (6.9) | 2089 (7.4) | |
Hispanic ethnicity | 2595 (8.3) | 2952 (10.4) | < 0.001 |
Insurance status | |||
Medicare | 17,080 (54.5) | 15,052 (53.2) | < 0.001 |
Medicaid | 3592 (11.5) | 3500 (12.4) | |
Commercial | 8678 (27.7) | 7993 (28.2) | |
Military/Veterans Affairs | 272 (0.9) | 192 (0.7) | |
Non-US Insurance | 507 (1.6) | 378 (1.3) | |
Self-pay (uninsured) | 589 (1.9) | 610 (2.2) | |
Unknown/other | 652 (2.1) | 579 (2.1) | |
Rural residence | 881 (2.8) | 728 (2.6) | 0.08 |
Area Deprivation Index percentile, median (IQR) | 58 (36 – 78) | 58 (33 – 80) | 0.15 |
Performance site | |||
Hospital outpatient | 24,784 (79.0) | 22,147 (78.2) | < 0.001 |
Hospital inpatient | 5457 (17.4) | 4614 (16.3) | |
Ambulatory center | 1093 (3.5) | 1491 (5.3) | |
Office | 32 (0.1) | 47 (0.2) | |
Not reported | 4 (0.01) | 5 (0.02) | |
Transfer status | |||
From another hospital | 498 (1.6) | 307 (1.1) | < 0.001 |
From rehabilitation unit | 190 (0.6) | 121 (0.4) | |
Comorbidities | |||
Smoking status | |||
Never | 15,067 (48.0) | 14,173 (50.1) | < 0.001 |
Prior | 11,746 (37.4) | 10,070 (35.6) | |
Current | 4,557 (14.5) | 4,061 (14.3) | |
Hypertension | 29,382 (93.7) | 26,637 (94.1) | < 0.001 |
Diabetes | 19,141 (61.0) | 17,127 (60.5) | < 0.001 |
Coronary artery disease | 8091 (25.8) | 6575 (23.2) | < 0.001 |
Prior coronary artery bypass | 3234 (10.3) | 2594 (9.2) | < 0.001 |
Prior percutaneous coronary intervention | 4084 (13.0) | 3310 (11.7) | < 0.001 |
Congestive heart failure | 9947 (31.7) | 8543 (30.2) | < 0.001 |
Dysrhythmia | 2349 (7.5) | 1458 (5.2) | < 0.001 |
Chronic obstructive pulmonary disease | |||
Not treated | 1134 (3.6) | 1013 (3.6) | < 0.001 |
On medications | 3780 (12.0) | 2825 (10.0) | |
On home oxygen | 1305 (4.2) | 851 (3.0) | |
Peripheral artery disease | 24,148 (77.0) | 22,957 (81.1) | < 0.001 |
Intravenous drug use | |||
Past | 474 (1.5) | 425 (1.5) | 0.001 |
Current | 197 (0.6) | 116 (0.4) | |
HIV status | |||
HIV+ | 287 (0.9) | 289 (1.0) | < 0.001 |
HIV+ with current infection | 53 (0.2) | 78 (0.3) | |
CKD stage | |||
1 | 4 (0.01) | 5 (0.02) | < 0.001 |
2 | 4 (0.01) | 8 (0.03) | |
3 | 118 (0.4) | 63 (0.2) | |
4 | 2266 (7.2) | 1259 (4.5) | |
5 | 28,978 (92.4) | 26,969 (95.3) | |
Dialysis status | |||
Pre-dialysis | 11,648 (37.1) | 7548 (26.7) | < 0.001 |
On hemodialysis | 19,347 (61.7) | 20,485 (72.4) | |
On peritoneal dialysis | 176 (0.6) | 117 (0.4) | |
Functioning transplant, never on dialysis | 133 (0.4) | 110 (0.4) | |
Functioning transplant, previously on dialysis | 56 (0.2) | 29 (0.1) | |
Not reported | 10 (0.03) | 15 (0.05) | |
ASA class | |||
1 | 77 (0.2) | 44 (0.2) | < 0.001 |
2 | 888 (2.8) | 819 (2.9) | |
3 | 18,295 (58.3) | 16,994 (60.0) | |
4 | 11,976 (38.2) | 10,346 (36.6) | |
5 | 26 (0.08) | 16 (0.06) | |
Not reported | 108 (0.3) | 85 (0.3) | |
Functional status | |||
Living status | |||
Home | 29,852 (95.2) | 27,267 (96.3) | < 0.001 |
Nursing home | 1385 (4.4) | 926 (3.3) | |
Homeless | 86 (0.3) | 80 (0.3) | |
Not reported | 47 (0.2) | 31 (0.1) | |
Ambulatory status | |||
Ambulatory independently | 26,174 (83.4) | 23,765 (84.0) | < 0.001 |
Ambulatory with assistance | 3541 (11.3) | 3204 (11.3) | |
Wheelchair-dependent | 1458 (4.7) | 1208 (4.3) | |
Bedridden | 197 (0.6) | 127 (0.4) | |
Laboratory investigations | |||
Hemoglobin, g/L, mean (SD) | 107.0 (44.8) | 106.0 (17.5) | < 0.001 |
Creatinine, umol/L, mean (SD) | 408.0 (98.3) | 427.0 (93.4) | < 0.001 |
Estimated glomerular filtration rate, mL/min/1.73 m2, mean (SD) | 13.1 (1.9) | 12.9 (1.5) | < 0.001 |
Medications | |||
Acetylsalicylic acid | 4385 (14.0) | 3417 (12.1) | < 0.001 |
P2Y12 antagonist | 1145 (3.6) | 902 (3.2) | 0.005 |
Statin | 6389 (20.4) | 4687 (16.6) | < 0.001 |
Anticoagulant | 777 (2.5) | 1233 (4.4) | < 0.001 |
Vascular access history | |||
Number of prior AV fistula creation procedures | |||
0 | 27,782 (88.6) | 24,381 (86.1) | < 0.001 |
1 | 2704 (8.6) | 2980 (10.5) | |
2 | 675 (2.2) | 727 (2.6) | |
3 | 158 (0.5) | 157 (0.6) | |
4 or more | 51 (0.2) | 59 (0.2) | |
Number of prior AV graft creation procedures | |||
0 | 29,919 (95.4) | 26,761 (94.5) | < 0.001 |
1 | 1155 (3.7) | 1193 (4.2) | |
2 | 233 (0.7) | 284 (1.0) | |
3 | 39 (0.1) | 55 (0.2) | |
4 or more | 24 (0.08) | 11 (0.04) | |
Previous forearm fistula | 2835 (9.0) | 3037 (10.7) | < 0.001 |
Previous upper arm fistula | 3093 (9.9) | 3313 (11.7) | < 0.001 |
Previous forearm graft | 731 (2.3) | 854 (3.0) | < 0.001 |
Previous upper arm graft | 1374 (4.4) | 1612 (5.7) | < 0.001 |
Previous lower extremity AV access | 318 (1.0) | 360 (1.3) | 0.03 |
Other AV access | 1602 (5.1) | 1573 (5.6) | 0.01 |
Imaging and anatomic characteristics | |||
Pre-operative imaging | |||
Arterial duplex | 10,734 (34.2) | 10,408 (36.8) | < 0.001 |
Arteriogram | 428 (1.4) | 460 (1.6) | 0.009 |
Ultrasound vein mapping | 26,836 (85.5) | 24,354 (86.0) | 0.08 |
Venogram | 2289 (7.3) | 3037 (10.7) | < 0.001 |
Pre-operative target inflow artery diameter, mm, mean (SD) | 4.09 (0.41) | 4.21 (0.38) | < 0.001 |
Pre-operative target outflow vein diameter, mm, mean (SD) | 3.59 (0.84) | 3.74 (0.92) | < 0.001 |
Access type | |||
AV fistula | 24,668 (78.6) | 22,903 (80.9) | < 0.001 |
AV graft | 6700 (21.4) | 5401 (19.1) | |
Inflow artery | |||
Radial | 8134 (25.9) | 6378 (22.5) | < 0.001 |
Ulnar | 80 (0.3) | 56 (0.2) | |
Brachial | 21,830 (69.6) | 20,361 (71.9) | |
Axillary | 596 (1.9) | 669 (2.4) | |
Common femoral | 232 (0.7) | 260 (0.9) | |
Superficial femoral | 229 (0.7) | 293 (1.0) | |
Other | 269 (0.9) | 287 (1.0) | |
Outflow vein | |||
Cephalic, forearm | 13,789 (44.0) | 11,819 (41.8) | < 0.001 |
Cephalic, upper arm | 3711 (11.5) | 3216 (11.4) | |
Basilic, forearm | 1309 (4.2) | 935 (3.3) | |
Basilic, upper arm | 6245 (19.9) | 5768 (20.4) | |
Brachial | 1346 (4.3) | 1339 (4.7) | |
Axillary | 3717 (11.8) | 3914 (13.8) | |
Saphenous | 96 (0.3) | 115 (0.4) | |
Femoral | 374 (1.2) | 435 (1.5) | |
Other | 783 (2.5) | 763 (2.7) | |
Pre-operative endovascular arterial intervention (angioplasty/stent) to treat inflow stenosis | 193 (0.6) | 205 (0.7) | 0.11 |
Pre-operative endovascular venous intervention (angioplasty/stent) to treat outflow stenosis | 418 (1.3) | 436 (1.5) | 0.04 |