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Factors predicting failure of AV “fistula first” policy in the elderly
Author(s) -
Hod Tammy,
DeSilva Ranil N.,
Patibandla Bhanu K.,
Vin Yael,
Brown Robert S.,
GoldfarbRumyantzev Alexander S.
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12106
Subject(s) - medicine , hemodialysis , dialysis , nephrology , arteriovenous fistula , confidence interval , odds ratio , population , logistic regression , end stage renal disease , cardiology , surgery , environmental health
An arteriovenous fistula ( AVF ) is the preferential hemodialysis ( HD ) access. The goal of this study was to identify factors associated with pre‐dialysis AVF failure in an elderly HD population. We used U nited S tates R enal D ata S ystem + M edicare claims data to identify patients ≥67 years old who had an AVF as their initial vascular access placed pre‐dialysis. Failure of the AVF to be used for initial HD , was used as the outcome. Logistic regression model was used to identify factors associated with AVF failure. The study cohort consisted of 20,360 subjects (76.2 ± 6.02 year old, 58.5% men). Forty‐eight percent of patients initiated dialysis using an AVF , while 52% used a catheter or an AVG . The following variables found to be associated with AVF failure when an AVF was created at least 4 months pre‐ HD initiation: older age (odds ratio [ OR ] 1.01; 95% confidence interval [ CI ] 1.00–1.02), female gender ( OR 1.69; 95% CI 1.55–1.83), black race ( OR 1.41; 95% CI 1.26–1.58), history of diabetes ( OR 1.22; 95% CI 1.06–1.39), cardiac failure ( OR 1.26; 95% CI 1.15–1.37), and shorter duration of pre–end‐stage renal disease ( ESRD ) nephrology care ( OR for a nephrology care of less than 6 months prior to ESRD of 1.22 compared with a pre‐ ESRD nephrology follow up of more than 12 months; 95% CI 1.07–1.38). OR for AVF failure for the entire cohort showed similar findings. In an elderly HD population, there is an association of older age, female gender, black race, diabetes, cardiac failure and shorter pre‐ ESRD nephrology care with predialysis AVF failure.