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Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study

BACKGROUND: Fistula creation is recommended to avoid the use of central venous catheters for hemodialysis. The extent to which timing of fistula creation minimizes catheter use is unclear. OBJECTIVE: To compare patient outcomes of 2 fistula creation strategies: fistula attempt prior to the initiatio...

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Autores principales: Clarke, Alix, Ravani, Pietro, Oliver, Matthew J., Hiremath, Swapnil, Blake, Peter G., Moist, Louise M., Garg, Amit X., Lam, Ngan N., Quinn, Robert R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506926/
https://www.ncbi.nlm.nih.gov/pubmed/31105964
http://dx.doi.org/10.1177/2054358119843139
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author Clarke, Alix
Ravani, Pietro
Oliver, Matthew J.
Hiremath, Swapnil
Blake, Peter G.
Moist, Louise M.
Garg, Amit X.
Lam, Ngan N.
Quinn, Robert R.
author_facet Clarke, Alix
Ravani, Pietro
Oliver, Matthew J.
Hiremath, Swapnil
Blake, Peter G.
Moist, Louise M.
Garg, Amit X.
Lam, Ngan N.
Quinn, Robert R.
author_sort Clarke, Alix
collection PubMed
description BACKGROUND: Fistula creation is recommended to avoid the use of central venous catheters for hemodialysis. The extent to which timing of fistula creation minimizes catheter use is unclear. OBJECTIVE: To compare patient outcomes of 2 fistula creation strategies: fistula attempt prior to the initiation of dialysis (“predialysis”) or fistula attempt after starting dialysis (“postinitiation”). DESIGN: Cohort study. SETTING: Five Canadian dialysis programs. PATIENTS: Patients who started hemodialysis between 2004 and 2012, who underwent fistula creation, and were tracked in the Dialysis Measurement Analysis and Reporting (DMAR) system. MEASUREMENTS: Catheter-free fistula use within 1 year of hemodialysis start, probability of catheter-free fistula use during follow-up, and rates of access-related procedures. METHODS: Retrospective data analysis: logistic regression; negative binomial regression. RESULTS: Five hundred and eight patients had fistula attempts predialysis and 583 postinitiation. At 1 year, 80% of those with predialysis attempts achieved catheter-free use compared to 45% with post-initiation attempts (adjusted odds ratio [OR](preVSpost) = 4.67; 95% confidence interval [CI] = 3.28-6.66). The average of all patient follow-up time spent catheter-free was 63% and 28%, respectively (probability of use per unit time, OR(preVSpost) = 2.90; 95% CI = 2.18-3.85). This finding was attenuated when accounting for maturation time and when restricting the analysis to those who achieved catheter-free use. Predialysis fistula attempts were associated with lower procedure rates after dialysis initiation—1.61 procedures per person-year compared with 2.55—but had 0.65 more procedures per person prior to starting dialysis. LIMITATIONS: Observational design, unknown indication for predialysis and postinitiation fistula creation, and unknown reasons for prolonged catheter use. CONCLUSIONS: Predialysis fistula attempts were associated with a higher probability of catheter-free use and remaining catheter-free over time, and also resulted in fewer procedures compared with postinitiation attempts, which could be due to timing of attempt or patient factors. Catheter use and procedures were still common for all patients, regardless of the timing of fistula creation.
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spelling pubmed-65069262019-05-17 Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study Clarke, Alix Ravani, Pietro Oliver, Matthew J. Hiremath, Swapnil Blake, Peter G. Moist, Louise M. Garg, Amit X. Lam, Ngan N. Quinn, Robert R. Can J Kidney Health Dis Original Research Article BACKGROUND: Fistula creation is recommended to avoid the use of central venous catheters for hemodialysis. The extent to which timing of fistula creation minimizes catheter use is unclear. OBJECTIVE: To compare patient outcomes of 2 fistula creation strategies: fistula attempt prior to the initiation of dialysis (“predialysis”) or fistula attempt after starting dialysis (“postinitiation”). DESIGN: Cohort study. SETTING: Five Canadian dialysis programs. PATIENTS: Patients who started hemodialysis between 2004 and 2012, who underwent fistula creation, and were tracked in the Dialysis Measurement Analysis and Reporting (DMAR) system. MEASUREMENTS: Catheter-free fistula use within 1 year of hemodialysis start, probability of catheter-free fistula use during follow-up, and rates of access-related procedures. METHODS: Retrospective data analysis: logistic regression; negative binomial regression. RESULTS: Five hundred and eight patients had fistula attempts predialysis and 583 postinitiation. At 1 year, 80% of those with predialysis attempts achieved catheter-free use compared to 45% with post-initiation attempts (adjusted odds ratio [OR](preVSpost) = 4.67; 95% confidence interval [CI] = 3.28-6.66). The average of all patient follow-up time spent catheter-free was 63% and 28%, respectively (probability of use per unit time, OR(preVSpost) = 2.90; 95% CI = 2.18-3.85). This finding was attenuated when accounting for maturation time and when restricting the analysis to those who achieved catheter-free use. Predialysis fistula attempts were associated with lower procedure rates after dialysis initiation—1.61 procedures per person-year compared with 2.55—but had 0.65 more procedures per person prior to starting dialysis. LIMITATIONS: Observational design, unknown indication for predialysis and postinitiation fistula creation, and unknown reasons for prolonged catheter use. CONCLUSIONS: Predialysis fistula attempts were associated with a higher probability of catheter-free use and remaining catheter-free over time, and also resulted in fewer procedures compared with postinitiation attempts, which could be due to timing of attempt or patient factors. Catheter use and procedures were still common for all patients, regardless of the timing of fistula creation. SAGE Publications 2019-05-07 /pmc/articles/PMC6506926/ /pubmed/31105964 http://dx.doi.org/10.1177/2054358119843139 Text en © The Author(s) 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Clarke, Alix
Ravani, Pietro
Oliver, Matthew J.
Hiremath, Swapnil
Blake, Peter G.
Moist, Louise M.
Garg, Amit X.
Lam, Ngan N.
Quinn, Robert R.
Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title_full Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title_fullStr Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title_full_unstemmed Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title_short Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
title_sort timing of fistula creation and the probability of catheter-free use: a cohort study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506926/
https://www.ncbi.nlm.nih.gov/pubmed/31105964
http://dx.doi.org/10.1177/2054358119843139
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