Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease

Abstract

The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care among a representative United States (US) population of end stage kidney disease (ESKD) patients, including by age, race and sex. All Medicare beneficiaries >20 years of age who underwent AVF graft creation for ESKD between 2017 through 2019 were included for analysis. The primary endpoints included primary patency, primary assisted patency, post-intervention patency, and fistula functionality up to one year after AVF placement. Secondary endpoint included admission for an associated adverse event following AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at one year was 31.5%. At one year, the primary assisted patency rate, post-intervention patency, and fistula use were 70.4%, 30.2% and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 – 59: HR 1.01 [95% CI 0.95 – 1.06], p = 0.84) or age ≥60: HR 0.99 [95% CI 0.93 – 1.04], p = 0.61) to the reference of age group 20 – 39. Women vs men (HR 1.16 [95% CI 1.14 – 1.20], p < 0.001) and Black vs White patients (HR 1.34 [95% CI 1.31 – 1.38], p < 0.001) and were at higher risk of experiencing primary patency failure. The cumulative incidence of admissions for adverse events was 32.6% at 1-year. In conclusion, our findings suggest that the real-world AVF patency rates remain low, with disproportionately low rates among women and Black patients.