Multidisciplinary Vascular Access Team Impact on the Number of Arteriovenous Fistulae and 12-Month Mortality

Background: Autologous arteriovenous fistulae (AVF) are the vascular access (VA) of choice for most haemodialysis (HD) patients. The creation of multidisciplinary VA teams (mVAT) improves access-related outcomes, and thus overall survival. This study evaluates our center’s mVAT impact on matured AVFs and 12-month mortality. Methods: A retrospective case-control analysis was performed, comparing our center’s incident HD patients from years 2019 and 2022. A mVAT was created in 2021. Patient data was collected from their electronic health record, namely demographic variables, comorbidities, prior nephrology (NA) and vascular access appointments (VAA), access typology at the beginning of HD and the number of unprogrammed initiations. The primary outcome was the number of functioning AVFs in incident and 12-month prevalent HD patients. Secondarily, 12-month mortality was assessed, and its clinical predictors were derived from a combined-year Cox proportional hazard regression model. Results: 169 and 184 incident HD patients were included from 2022 and 2019, respectively. There were no significant differences between years regarding demographic variables, comorbidities, prior NA/ VAA/ VA construction, and the number of unprogrammed initiations. More incidents started HD with an AVF in 2022 (50.9% vs 37.5%, p= .011), independently of demographic variables and comorbidities. The number of functioning AVFs in 12-month HD prevalents was also greater (85.2% vs 76.6%, p = .041). The 12-month cumulative mortality was 11.2% and 14.7% in 2022 and 2019, respectively (Log Rank X2(1) = 0.881; p= .348), with no significant differences regarding the categorized cause of death between years. In our combined-cohort Cox proportional hazard regression model (X2 (11) = 180.266; p < .001), age (HR 1.05, p= .009) and initiation with a CVC (HR 10.01, p< .001) were predictors of 12-month mortality; and VA construction (HR 0.09, p < .001) and the number of days with a CVC (HR 0.988, p < .001) were negative predictors. No comorbidity obtained statistical significance after adjustment. Conclusion: Our mVAT impacted both the number of functioning AVFs in incident and 12-month prevalent HD patients. We did not detect a significant mortality difference between years. HD initiation with a CVC appears to be the strongest 12-month mortality predictor.