Study finds longer catheter use, higher mortality for US patients on dialysis
A study that compared international vascular access practice patterns showed several regional differences regarding arteriovenous fistula patency and time to becoming catheter-free for patients on hemodialysis.
According to Ronald L. Pisoni, PhD, MS, of Arbor Research Collaborative for Health, and colleagues, the differences observed highlight the importance of understanding the specific factors, technologies and approaches that could improve vascular access procedures across regions.
Using data from the Dialysis Outcomes and Practice Patterns Study, researchers included 2,040 patients who received hemodialysis at 466 facilities in the United States, Japan and EUR/ANZ (consisting of Belgium, France, Germany, Italy, Spain, Sweden, United Kingdom, Australia and New Zealand). A total of 2,191 newly created arteriovenous fistulas (AVF) were examined, with considerations made for demographics, comorbidities, dialysis vintage, BMI, AVF location and country/region.
Outcomes included primary/cumulative AVF patency from creation, primary/cumulative functional patency from first use, catheter-dependence duration and mortality.
Median dialysis vintage was determined to be 0.3 to 3.2 years, with 84%, 54% and 32% of AVFs created in the forearm in Japan, EUR/ANZ and the U.S., respectively.
Results showed superior primary and cumulative patencies in Japan compared with the U.S. and EUR/ANZ.
According to researchers, this finding was due to higher successful AVF use in Japan, as catheter-dependence following AVF creation was longer in EUR/ANZ and U.S. patients, with nearly 70% remaining catheter-dependent 8 months after AVF creation when AVFs were not successfully used.
“In Japan, 80% of these patients were [central venous catheter] CVC-free within approximately 15 days whereas 70 days and 101 days were required in EUR/ANZ and the U.S. for 50% of patients to become CVC-free after AVF creation,” Pisoni and colleagues wrote. “In both EUR/ANZ and the U.S., approximately 20% of patients, who had an AVF created and were using a CVC at time of AVF creation, were still using the CVC 8 months after AVF creation and had not used any other AV access during that time.”
In addition, researchers found not using an AV access within 6 months of AVF creation was associated with a 53% higher mortality rate in the following 6 months.
“Our findings highlight the need to reevaluate practices for optimizing long-term access planning and achievable AVF outcomes, especially AVF maturation,” Pisoni and colleagues concluded, adding, “[t]hese international comparisons may provide important guidance for U.S. clinicians seeking to achieve vascular access success comparable to Europe and Japan, and increase long-term use of forearm AVFs in appropriate patients.”