Abstract: SA-PO949
Gender Disparities in Vascular Access Surgical Outcomes Among Elderly Hemodialysis Patients
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Lee, Timmy C., Univ of Alabama at Birmingham, Birmingham, Alabama, United States
- Qian, Joyce Z., Johns Hopkins University, Baltimore, Maryland, United States
- Thamer, Mae, MTPPI, Bethesda, Maryland, United States
- Allon, Michael, University of Alabama at Birmingham, Birmingham, Alabama, United States
Background
Despite national vascular access guidelines promoting use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVG) for dialysis, AVF use is substantially lower in females. The objective of this study was to assess clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC).
Methods
Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (>67 years) (4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter, and received an AVF or AVG placed within 6 months. We evaluated vascular access placement, maturation (successful use for diaysis), assisted maturation (requiring an intervention before maturation), abandonment after maturation, and rate of interventions after maturation.
Results
Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% confidence interval [CI] 0.52-0.63). Among patients receiving an AVF (Fig. 1), females had higher adjusted likelihoods of AVF non-maturation (HR 1.46, 95% CI 1.36-1.56), assisted AVF maturation (OR 1.34, 95% CI 1.17-1.54), and AVF abandonment (HR 1.28, 95% CI 1.10-1.50), but similar relative rate of AVF interventions after maturation (RR 1.01, 95% CI 0.94-1.08). Among patients receiving an AVG, females had a lower likelihood of AVG non-maturation (HR 0.83, 95% CI 0.73-0.94), similar rates of assisted AVG maturation (OR 1.05, 95% CI 0.78-1.40) and AVG abandonment, and greater relative rate of interventions after AVG maturation (RR 1.16, 95% CI, 1.01-1.33).
Conclusion
In elderly patients initiating hemodialysis with a catheter, clinical AVF surgical outcomes are uniformly worse in females. AVGs may be a viable alternative, notwithstanding current national recommendations.
Funding
- NIDDK Support