Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States

Hemodialysis is a lifesaving procedure that requires a person to be connected to a dialysis machine by tubing that delivers fluid exchange. A vascular access is needed for this connection, with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) being two common types of vascular access.  AVFs and AVGs typically are surgically created in a patient’s arm but often require procedures to either become functional (during maturation phase) or maintain function after first use (maintenance phase). Using data from the United States Renal Data System (USRDS), our researchers calculated access procedure (intervention) rates in the US for patients starting hemodialysis with an AVF or AVG created during their first year of hemodialysis therapy between July 1, 2012 and December 31, 2014 (N = 73,027). Subsequent access-related procedures were included in analyses through Dec. 31, 2016. Interventions were common for both AVFs and AVGs as the access matured, with 13,989 of 57,275 (24.4%) AVFs requiring a procedure (0.36 AVF procedures/patient) and 2,904 of 15,572 (18.4%) AVG patients requiring intervention (0.28 AVG procedures/patient during maturation. However, during the maintenance phase, procedure rates were considerably lower for AVFs (0.93 procedures/patient occurring in 40% of patients) than for AVGs (1.87 procedures/patient occurring in 58% of patients). Thus, during maturation, interventions are carried out in 18-24% of newly created AVFs and AVGs. Once successfully matured, AVF had 50% lower maintenance interventional requirements. The full text is available here: https://www.ajkd.org/article/S0272-6386(21)00511-4/fulltext