Abstract
BackgroundCardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes.MethodsWe conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients’ characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period.ResultsThe patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin–angiotensin–aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48–0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39–0.59]). Sensitivity analyses obtained consistent results.ConclusionsPre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.
Highlights
End-stage renal disease (ESRD) has become a major public health issue because of its prevalence in more than two million people worldwide and increasing incidence
We examined congestive heart failure (CHF) hospitalization rate in the propensity-score-matched groups, which showed a similar trend
We revealed that patients in the pre-HD arteriovenous access (AVA) group had a 52% lower rate of all-cause mortality, a marginally lower rate of major adverse cardiovascular events (MACEs)-related mortality, and a 68% lower rate of bloodstream infection (BSI)-related mortality
Summary
End-stage renal disease (ESRD) has become a major public health issue because of its prevalence in more than two million people worldwide and increasing incidence. Among the major causes of mortality, cardiovascular (CV) disease contributes nearly half of the events in this population (Collins et al, 2010). Creation of arteriovenous access (AVA), such as native fistula or artificial graft, is one of the crucial methods of care planning. It prevents the complications from delayed dialysis and catheter-related infectious events (Oliver et al, 2004). Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Conclusions: Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis
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