title: Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry.
abstract: BACKGROUND
  Although arteriovenous fistulas (AVFs) are actively promoted, their use at the start of haemodialysis (HD) seems to be decreasing worldwide. In this paper, we describe recent trends in incidence and prevalence of vascular access types in Europe from 2005 to 2009 and their relationship with patient characteristics and survival.
  
  
  METHODS
  Ten European renal registries participating in the ERA-EDTA Registry provided data on incidence (n = 13,044) and/or prevalence (n = 75,715) of vascular access types. We used logistic regression to assess which factors influence the likelihood to be treated with an AVF rather than another type.
  
  
  RESULTS
  The use of AVFs at the start of HD showed a significant decreasing trend from 42% in 2005 to 32% in 2009 (P < 0.0001), while the use of central venous catheters (CVCs) increased from 58 to 68% (P < 0.0001). A similar evolution pattern was observed for the prevalence; use of AVFs decreased from 66 to 62% and use of CVCs increased from 28 to 32%. There was a large international variation in the use of the different vascular access types. Female patients [adjusted odds ratio: 0.84, 95% confidence interval (CI): 0.78-0.90] and those ≥80 years (0.77, 95% CI: 0.67-0.90) were least likely to start HD with an AVF.
  
  
  CONCLUSIONS
  In Europe, there is a decreasing trend in the use of AVFs and an increasing trend in the use of CVCs at the start and after the start of HD. We cannot explain all between-country variations we found, and more research is needed to clarify how healthcare around vascular access is organized in Europe.
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Marlies
authors: M
authors: Noordzij
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Kitty J
authors: KJ
authors: Jager
authors: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium.
authors: Sabine N
authors: SN
authors: van der Veer
authors: Austrian Dialysis and Transplant Registry, Kematen ad Krems, Austria.
authors: Reinhard
authors: R
authors: Kramar
authors: French-Belgian ESRD Registry, Brussels, Belgium.
authors: Frederic
authors: F
authors: Collart
authors: Department of Nephrology, University of Copenhagen Herlev, Copenhagen, Denmark.
authors: James G
authors: JG
authors: Heaf
authors: University Clinic of Nephrology, Medical Faculty, University 'Sts. Cyril and Methodius', Skopje, FYR of Macedonia.
authors: Olivera
authors: O
authors: Stojceva-Taneva
authors: The Norwegian Renal Registry, Renal Unit, Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Torbjørn
authors: T
authors: Leivestad
authors: Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Jadranka
authors: J
authors: Buturovic-Ponikvar
authors: Department of Nephrology, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors: Manuel
authors: M
authors: Benítez Sánchez
authors: Catalonian Registry of Renal Patients, Nephrology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors: Fransesc
authors: F
authors: Moreso
authors: Swedish Renal Registry, Jönköping, Sweden Department of Internal Medicine, Hospital of Helsingborg, Helsingborg, Sweden.
authors: Karl G
authors: KG
authors: Prütz
authors: Ninewells Hospital, Dundee,UK.
authors: Alison
authors: A
authors: Severn
authors: Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Nephrology Section, Ghent University Hospital, Ghent, Belgium.
authors: Raymond
authors: R
authors: Vanholder
authors: Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada.
authors: Pietro
authors: P
authors: Ravani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000639:trends*; D002405:Catheterization, Central Venous / Q000639:trends*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis; D015996:Survival Rate; D055815:Young Adult
keywords: AV fistula; catheter; haemodialysis; mortality; vascular access