title: Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons.
abstract: BACKGROUND
  Since the bundled end-stage renal disease prospective payment system began in 2011 in the United States, some hemodialysis practices have changed substantially, raising the question of whether vascular access practice also has changed. We describe monthly US vascular access use from August 2010 to August 2013 with international comparisons, and other aspects of US vascular access practice.
  
  
  METHODS
  Prospective observational cohort study of vascular access.
  
  
  METHODS
  Maintenance hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor (DPM) in the United States (N=3,442; US patients) and 19 other nations (N=8,478).
  
  
  METHODS
  Country, patient demographics, time period.
  
  
  RESULTS
  Vascular access use, pre-end-stage renal disease access timing of first nephrologist care and arteriovenous access placement, patient self-reported vascular access preferences (United States only), treatment practices as stated by medical directors.
  
  
  RESULTS
  In the United States from August 2010 to August 2013, arteriovenous fistula (AVF) use increased from 63% to 68%, while catheter use declined from 19% to 15%. Although AVF use did not differ greatly across age groups, arteriovenous graft use was 2-fold higher among black (26%) versus nonblack US patients (13%) in 2013. Across 20 countries in 2013, AVF use ranged from 49% to 92%, whereas catheter use ranged from 1% to 45%. Patient-reported vascular access preferences differed by sex and race, with 16% to 20% of patients feeling uninformed regarding benefits/risks of different vascular access types. Among new (incident) US hemodialysis patients, AVF use remains low, with ∼70% initiating hemodialysis therapy with a catheter (60% starting with catheter when having ≥4 months of predialysis nephrology care). In the United States, longer typical times to first AVF cannulation were reported.
  
  
  CONCLUSIONS
  Noncompletion of surveys may affect the generalizability of findings to the wider hemodialysis population.
  
  
  CONCLUSIONS
  AVF use has increased, with catheter use decreasing among prevalent US hemodialysis patients since the introduction of the prospective payment system. However, AVF use at dialysis therapy initiation remains low, suggesting that reforms affecting predialysis care may be necessary to incentivize improvements in fistula rates at dialysis therapy initiation as achieved for prevalent hemodialysis patients.
authors: Arbor Research Collaborative for Health, Ann Arbor, MI. Electronic address: ronald.pisoni@arborresearch.org.
authors: Ronald L
authors: RL
authors: Pisoni
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Lindsay
authors: L
authors: Zepel
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Friedrich K
authors: FK
authors: Port
authors: Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors: Bruce M
authors: BM
authors: Robinson
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data* / Q000639:trends; D062905:Central Venous Catheters / Q000706:statistics & numerical data* / Q000639:trends; D015331:Cohort Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D057240:Patient Preference / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D006435:Renal Dialysis / Q000639:trends*; D014481:United States; D062666:Vascular Access Devices / Q000706:statistics & numerical data* / Q000639:trends; D044465:White People / Q000706:statistics & numerical data
keywords: DOPPS Practice Monitor (DPM); Dialysis Outcomes and Practice Patterns Study (DOPPS); Hemodialysis; arteriovenous fistula (AVF); arteriovenous graft (AVG); central venous catheter (CVC); dialysis initiation; nephrology referral; practice patterns; renal replacement therapy (RRT); treatment practices; vascular access