title: Comparison of vascular access outcomes in patients with end-stage renal disease attributed to systemic lupus erythematosus vs. other causes: a retrospective cohort study.
abstract: U.S. hemodialysis patients with systemic lupus erythematosus (SLE) and end-stage renal disease (ESRD) are less likely than other ESRD patients to have a permanent vascular access (fistula or graft) in place at the dialysis start. We examined whether vascular access outcomes after dialysis start differed for SLE vs. other ESRD patients.
  
  
  
  Among U.S. patients initiating hemodialysis in 2010 with only a catheter (n = 40,911; 384 with SLE) and using a permanent access on first dialysis (n = 13,073; 48 with SLE), we examined the association of SLE status with time to first placement of a permanent access (among catheter-only patients) and to loss of access patency (among patients using a permanent access on first dialysis), both censored 1 year after dialysis start, using multivariable Cox proportional hazards models.
  
  
  
  Among catheter-only patients, 46.1 % vs. 54.5 % of those with SLE-ESRD vs. other ESRD had a permanent access placed within 1 year after dialysis start. However, with adjustment, there was no association of 1-year placement with SLE status [HR = 1.00 (95 % CI, 0.86-1.17)]. SLE-ESRD vs. other ESRD patients starting dialysis with a permanent access were less likely to experience a 1-year loss of patency (43.8 % vs. 55.0 %), but this association was not statistically significant after adjustment [HR = 0.88 (0.57-1.37)].
  
  
  
  These results suggest that SLE-ESRD patients starting dialysis with a catheter are not more likely to have a permanent access placed in the first year of dialysis, despite an observed lack of association of SLE status with subsequent loss of vascular access patency among those starting dialysis with a permanent access.
authors.affiliation: Division of Renal Medicine, Department of Medicine, Emory University, 101 Woodruff Circle, 5105 Woodruff Memorial Building, Atlanta, GA, 30322, USA. laura.plantinga@emory.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.affiliation: Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.affiliation: Division of Transplantation, Department of Surgery, Emory University, Atlanta, GA, USA.|Emory Transplant Center, Emory Healthcare, Emory University, Atlanta, GA, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Division of Renal Medicine, Department of Medicine, Emory University, 101 Woodruff Circle, 5105 Woodruff Memorial Building, Atlanta, GA, 30322, USA.|Emory Transplant Center, Emory Healthcare, Emory University, Atlanta, GA, USA.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Pastan
authors.affiliation: Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Drenkard
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000628:therapy*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D058017:Vascular Grafting / Q000706:statistics & numerical data*; D055815:Young Adult