SP502VASCULAR ACCESS USE 2011 - 2014 IN GERMANY: A PROVIDER-REGISTRY BASED ANALYSIS

Abstract

Introduction and Aims: In a 2005-2009 cohort of patients on hemodialysis (HD) from the EDTA registry the rates of AV-fistulas (AVF) were decreasing in Europe. At the same time, DOPPS reports increasing use of central venous catheters (CVC) for vascular access (VA) for HD in most European countries. We analyzed VA types over time in a large, current cohort of chronic HD patients in Germany. Methods: The electronic registry of a large, nationwide non-profit provider was queried for all patients ( pts) who dialyzed between 2011 and 2014 for more than 90 days. Patient-related factors were age, sex, heart failure (HF), peripheral vascular disease (PVD), and diabetes (DM). Outcomes were VA rates in incident and prevalent patients. In patients with a CVC and an AVF or AVG at the same time, CVC was defined as the designated vascular access when it was used for more than 30 days. Results: Between 2011 and 2014 24,758 pts were observed. Mean age was 69.8 (SD 15.7) years (66.8 y in 2011 and 68.2 in 2014), 38.5% female, 36.5% had HF, 27.2% PVD, and 40.1% DM. CVC use in prevalent patients was 20.3% and showed a small increase over time from 19.5% in 2011 to 21.6% in 2014 (Figure 1). Concurrently, AVGs were decreasing (9.0% to 6.9%) while AVF remained essentially unchanged (71.5%). CVC rates were highest in women and pts > 75y and showed the largest increase over time in these groups. In incident pts, however, AVF were 46.9% in 2011 and decreased to 38.7% in 2014 (Figure 2). In pts who survived at least 2 years, AVF rates were 53.7%, 55.7%, 66.6% and 71.8% at 6, 12, 18 and 24 months, respectively, suggesting that a substantial number of CVC could be "converted" to AVF over a two year period after initiation of dialysis. Conclusions: In contrast to previous reports, in this large current cohort of HD pts in Germany AVF rates remained stable while CVC rates increased at the expense of AVG. AVF rates in incident patients, however, decreased. These results suggest that in addition to increasing the rate of primary AVF, efforts should be directed at a speedy conversion to an AVF or AVG in patients who start HD with a CVC so as to limit risk exposure time. (Figure Presented).