Intravenous Drug Use History Is Not Associated With Poorer Outcomes After Arteriovenous Access Creation

Abstract

Rising intravenous drug use (IVDU) paralleled with an increasing dialysis-dependent end-stage renal disease population may pose a challenge for creating and maintaining arteriovenous (AV) access for hemodialysis. We aimed to elucidate baseline characteristics and outcomes of AV access creation in the IVDU population. The Vascular Quality Initiative national database (2011-2018) was queried for patients undergoing AV access placement. Univariable and multivariable analyses comparing outcomes among patients with and without IVDU history were performed. Among 33,404 patients undergoing AV access creation, 601 (1.8%) had IVDU history—21.8% current and 78.2% past users. IVDU patients receiving AV access were more often younger, male, nonwhite, smokers, homeless, Medicaid recipients, and hospitalized at the time of surgery (P < .001 for all). They exhibited higher rates of congestive heart failure, chronic obstructive pulmonary disease, and human immunodeficiency virus/acquired immunodeficiency syndrome (P < .05 for all). They more frequently had tunneled catheters at the time of access creation (53.6% vs 42%; P < .001) and had a previous AV access (25.3% vs 21.7%; P = .002). IVDU patients more often received prosthetic AV grafts (28.6% vs 18%; P < .001) and more often had anastomoses created to basilic veins (33.1% vs 23.2%; P < .001) but less often to cephalic veins (36.8% vs 57.7%; P < .001). IVDU patients had longer postoperative length of stay (2 ± 6 days vs 0.9 ± 5 days; P < .001) but no significant difference in 30-day mortality (1.7% vs 1.2%; P = .3). Comparing IVDU vs no IVDU cohorts, 6-month access infection-free survival (91.4% vs 92.9%; P = .38), 6-month endovascular/open reintervention-free survival (73.3% vs 70.8%; P = .71), and 1-year postoperative survival (93.8% vs 93.7%; P = .64) were similar. On multivariable analysis, IVDU was independently associated with postoperative length of stay ≥1 day (odds ratio, 1.64; 95% confidence interval, 1.35-2; P < .001) but not with 30-day mortality or 6-month infection-free survival, 6-month reintervention-free survival, or 1-year all-cause mortality. IVDU history was not independently associated with major morbidity or mortality after AV access creation. IVDU patients more often received grafts and anastomoses to proximal arm veins. As these patients have more frequent comorbidities and socioeconomic vulnerability, surgeons may consider coordinating care with other medical and nonmedical providers. However, IVDU history alone should not preclude AV access creation.