Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients.
Administrative Claims, Healthcare
/ statistics & numerical data
Age Factors
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical
/ adverse effects
Female
Graft Occlusion, Vascular
/ epidemiology
Healthcare Disparities
/ statistics & numerical data
Humans
Kidney Failure, Chronic
/ therapy
Male
Medicare
/ statistics & numerical data
Renal Dialysis
/ adverse effects
Retrospective Studies
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
United States
/ epidemiology
Vascular Grafting
/ adverse effects
Vascular Patency
Arteriovenous fistula
Arteriovenous graft
Central venous catheter
End-stage renal disease
Hemodialysis
Vascular access intervention
Journal
American journal of nephrology
ISSN: 1421-9670
Titre abrégé: Am J Nephrol
Pays: Switzerland
ID NLM: 8109361
Informations de publication
Date de publication:
2019
2019
Historique:
received:
01
10
2018
accepted:
10
11
2018
pubmed:
14
12
2018
medline:
31
3
2020
entrez:
14
12
2018
Statut:
ppublish
Résumé
Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). 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 had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52-0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36-1.56), assisted AVF use (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 successful use (relative risk [RR] 1.01, 95% CI 0.94-1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73-0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78-1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01-1.33). While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.
Sections du résumé
BACKGROUND
Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed 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 had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use.
RESULTS
Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52-0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36-1.56), assisted AVF use (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 successful use (relative risk [RR] 1.01, 95% CI 0.94-1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73-0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78-1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01-1.33).
CONCLUSIONS
While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.
Identifiants
pubmed: 30544112
pii: 000495261
doi: 10.1159/000495261
pmc: PMC6336522
mid: NIHMS998729
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
11-19Subventions
Organisme : NIDDK NIH HHS
ID : R44 DK109789
Pays : United States
Organisme : NIDDK NIH HHS
ID : R21 DK104248
Pays : United States
Organisme : AHRQ HHS
ID : R03 HS022931
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS021229
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD013818
Pays : United States
Organisme : BLRD VA
ID : I01 BX003387
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL139692
Pays : United States
Informations de copyright
© 2018 S. Karger AG, Basel.
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