Haemodialysis Vascular Access Procedure Rate in Aotearoa New Zealand: A Data Linkage Analysis

Overview

Key Points:

In patients new to hemodialysis, the rate of procedures to maintain hemodialysis vascular access was 0.71 per patient-year.

The hazard of procedures differed by sex, body mass index, era, and treatment center and were higher in adults with a primary central venous catheter.

This patient and clinician priority outcome can inform shared decision making when planning KRT.

Background:

Patients and clinicians prioritize the need for procedures to maintain hemodialysis vascular access as a core research outcome. The lack of procedural data in population datasets has limited certainty about the frequency of procedural events.

Methods:

This is a national linkage analysis of registry and administrative health data. We included all patients who started KRT between 2004 and 2021 in New Zealand, including data from 2 years before and 2 years after hemodialysis commencement. The incidence rate of vascular access procedures per patient-year was calculated, and a multivariate flexible parametric model was used to estimate associations with demographic and clinical variables.

Results:

In 7725 patients, the average rate of vascular access procedures was 0.71 (95% confidence interval [CI], 0.70 to 0.72) procedures per patient-year, median 2 (quartiles 1–3) procedures. The hazard of procedures was associated with sex (adjusted hazard ratio [HR] female versus male, 1.09; 95% CI, 1.05 to 1.13) and body mass index (HR, 1.17; 95% CI, 1.10 to 1.24 body mass index >35 kg/m2 versus 18.5–24.9). Patients in most recent treatment periods experienced lower procedural hazard (HR, 0.77; 95% CI, 0.73 to 0.81 in 2017–2021 compared with 2002–2006), and the hazard varied among treating centers. Primary central venous catheter was associated with an increased procedural hazard (HR, 1.34; 95% CI, 1.28 to 1.40) compared with primary arteriovenous fistula or graft.

Conclusions: 

Half of the adults underwent two or fewer hemodialysis vascular access procedures in the 4-year period before and after hemodialysis commencement. Procedural rates differed by sex, body mass, treatment period, and treatment center and were higher in adults with a primary central venous catheter.