title: Vascular access for incident hemodialysis patients in Catalonia: analysis of data from the Catalan Renal Registry (2000-2011).
abstract: OBJECTIVE
  Arteriovenous fístula is the best vascular access (VA) for hemodialysis. We analyzed the VA used at first session and the factors associated with the likelihood to start hemodialysis by fistula in 2000-2011.
  
  
  METHODS
  Data of VA type were obtained in 9,956 incident hemodialysis patients from the Catalan Registry.
  
  
  RESULTS
  Overall, 47.9% of patients initiated hemodialysis with a fistula, 1.2% with a graft, 15.9% with a tunneled catheter and 35% with an untunneled catheter. The percentage of incident patients with fistula and catheter has remained stable at around 50% over the years. The likelihood to start hemodialysis with fistula was significantly lower in females [adjusted odds ratio: 0.69, 95% confidence interval (CI): 0.61-0.75], patients aged 18-44 years (0.78, 95% CI: 0.64-0.94), patients with comorbidity (0.67, 95% CI: 0.60-0.75) and tended to be lower in patients aged over 74 years (0.89, 95% CI: 0.78-1.01). The probability to use fistula was significantly higher in patients with polycystic kidney disease (2.08, 95% CI: 1.63-2.67), predialysis nephrology care longer than 2 years (4.14, 95% CI: 3.63-4.73) and steady chronic kidney disease (CKD) progression (10.97, 95% CI: 8.41-14.32). During 1 year of follow-up, 67.2% and 59.6% of patients using untunneled and tunneled catheter changed to fistula, respectively.
  
  
  CONCLUSIONS
  Starting hemodialysis by fistula was related with nonmodifiable patient characteristics and modifiable CKD practice processes, such as predialysis care duration. Half of the incident patients were exposed annually in Catalonia to potential catheter complications. This scenario can be improved by optimizing the processes of CKD care.
authors.affiliation: Coordinator of the vascular accesses working group of the Catalan Society of Nephrology (SCN), Barcelona - Spain.|Department of Nephrology, Hospital de Mollet, Barcelona - Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Roca-Tey
authors.affiliation: Registre de Malalts Renals de Catalunya (RMRC), Organització Catalana de Trasplantaments (OCATT), Health Department of Catalonia, Catalonia - Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Arcos
authors.affiliation: Registre de Malalts Renals de Catalunya (RMRC), Organització Catalana de Trasplantaments (OCATT), Health Department of Catalonia, Catalonia - Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Comas
authors.affiliation: Registre de Malalts Renals de Catalunya (RMRC), Organització Catalana de Trasplantaments (OCATT), Health Department of Catalonia, Catalonia - Spain.|Department of Nephrology, Hospital del Mar, Barcelona - Spain.
authors.forename: Higini
authors.initials: H
authors.lastname: Cao
authors.affiliation: Registre de Malalts Renals de Catalunya (RMRC), Organització Catalana de Trasplantaments (OCATT), Health Department of Catalonia, Catalonia - Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Tort
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000639:trends*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000639:trends*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000639:trends*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult