The Rate of Procedures Required to Maintain Hemodialysis Vascular Access

Key Points In patients new to hemodialysis, the rate of procedures to maintain hemodialysis vascular access was 0.71 per patient-year. The hazard of procedures differed by sex, body mass index, era, and treatment center and were higher in adults with a primary central venous catheter. This patient and clinician priority outcome can inform shared decision making when planning KRT. Background Patients and clinicians prioritize the need for procedures to maintain hemodialysis vascular access as a core research outcome. The lack of procedural data in population datasets has limited certainty about the frequency of procedural events. Methods This is a national linkage analysis of registry and administrative health data. We included all patients who started KRT between 2004 and 2021 in New Zealand, including data from 2 years before and 2 years after hemodialysis commencement. The incidence rate of vascular access procedures per patient-year was calculated, and a multivariate flexible parametric model was used to estimate associations with demographic and clinical variables. Results In 7725 patients, the average rate of vascular access procedures was 0.71 (95% confidence interval [CI], 0.70 to 0.72) procedures per patient-year, median 2 (quartiles 1–3) procedures. The hazard of procedures was associated with sex (adjusted hazard ratio [HR] female versus male, 1.09; 95% CI, 1.05 to 1.13) and body mass index (HR, 1.17; 95% CI, 1.10 to 1.24 body mass index >35 kg/m 2 versus 18.5–24.9). Patients in most recent treatment periods experienced lower procedural hazard (HR, 0.77; 95% CI, 0.73 to 0.81 in 2017–2021 compared with 2002–2006), and the hazard varied among treating centers. Primary central venous catheter was associated with an increased procedural hazard (HR, 1.34; 95% CI, 1.28 to 1.40) compared with primary arteriovenous fistula or graft. Conclusions Half of the adults underwent two or fewer hemodialysis vascular access procedures in the 4-year period before and after hemodialysis commencement. Procedural rates differed by sex, body mass, treatment period, and treatment center and were higher in adults with a primary central venous catheter.