Abstract
The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear. We aimed to explore the association between the slope of estimated glomerular filtration rate (eGFR) and the successful usage of vascular access upon hemodialysis initiation. This single center retrospective cohort study enrolled chronic kidney disease patients who undertook a multidisciplinary care program from 2003 to 2016. Using eGFR slope as predictor, we evaluated the vascular access created timely upon hemodialysis initiation. Among the 987 patients, vascular access was created at a median eGFR of 5.8 min/ml/1.73 m2, with a median duration of 3.1 months before hemodialysis. The proportions of vascular access created timely, created not timely (vascular access immature), and not created were 68.5%, 8.8%, and 22.7%, respectively. There was a significant negative association of eGFR upon vascular access creation with eGFR slope (r = − 0.182, P < 0.001). The fastest eGFR slope patients (the first quartile or < − 10 min/ml/1.73 m2/year) had the lowest percentage of vascular access created timely. In the multivariable logistic regression analysis, only higher eGFR upon vascular access creation (P = 0.001) and eGFR slope (P = 0.009) were significantly associated with vascular access created timely. The adjusted odds ratios of each quartile of eGFR slopes for vascular access created timely were 0.46 (95% confidence interval 0.27–0.86), 1.30 (0.62, 2.72), 1.00 (reference), and 0.95 (0.48–1.87), respectively. eGFR slope is associated with the timely creation of vascular access for the initiation of hemodialysis in a reverse-J-shaped pattern and may help determine the time of vascular access creation.
Highlights
The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear
We conducted this retrospective study to explore the factors associated with the timely preparation of vascular access (VA) creation in a chronic kidney disease (CKD) population undertaking a multidisciplinary CKD care program, focusing on the renal progression rate by testing the hypothesis that slower estimated glomerular filtration rate (eGFR) slope is associated with better VA creation timely
1435 patients entered maintenance HD. We excluded those who enrolled less than 180 days before the first HD (n = 411), whose VA status was unknown upon the first HD (n = 7), who had VA creation before CKD care program enrollment (n = 18), and those with fewer than three eGFR measurements available (n = 12)
Summary
The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear. Many factors have been proposed to explain the gap mentioned above, including mainly late referral, no disease insight, not being under regular pre-dialysis care, and an unpredicted clinical course[8,9,10] To overwhelm this gap, the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline suggests starting patient education on all modalities of kidney replacement options at an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m2. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline suggests starting patient education on all modalities of kidney replacement options at an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m2 It further recommends referral for VA assessment and subsequent creation when the eGFR is 15–20 mL/min/1.73 m2, given that it is unlikely to predict the time of dialysis initiation[11]. We conducted this retrospective study to explore the factors associated with the timely preparation of VA creation in a CKD population undertaking a multidisciplinary CKD care program, focusing on the renal progression rate by testing the hypothesis that slower eGFR slope is associated with better VA creation timely
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