title: Vascular access conversion and patient outcome after hemodialysis initiation with a nonfunctional arteriovenous access: a prospective registry-based study.
abstract: Little is known about vascular access conversion and outcomes for patients starting hemodialysis with nonfunctional arteriovenous (AV) access. We assessed mortality risk associated with nonfunctional AV access at hemodialysis initiation, taking subsequent changes in vascular access into account.
  
  
  
  We studied the 53,092 incident adult hemodialysis patients included in the French REIN registry from 2005 through 2012. AV access placed predialysis was considered nonfunctional when dialysis began with a central venous catheter. Information about vascular access changes was obtained from treatment modality updates.
  
  
  
  At hemodialysis initiation, AV access was functional for 47% of patients and nonfunctional for 9%; 44% had a catheter alone. After a 3-year follow-up, 63% of patients beginning hemodialysis with a nonfunctional AV access had changed to a functional one, 4% had had a transplant, 19% had died before any vascular access change, and 13% still used a catheter. Cox proportional hazard models with vascular access treated as a time-dependent variable showed an adjusted mortality hazard ratio (95% confidence interval) for patients with nonfunctional AV access who subsequently converted to functional access of 0.95 (95% CI 0.89-1.03) compared with the reference group with functional AV access since first hemodialysis, versus 1.43 (95% CI 1.31-1.55) for those who did not convert.
  
  
  
  Among patients starting hemodialysis with a nonfunctional AV access, a substantial percentage may never experience successful vascular access conversion. Poor survival seems to be limited to these patients, while those who subsequently convert to functional AV access have similar mortality risk compared to patients with such access since hemodialysis initiation. Every effort should be made to obtain functional AV access in all suitable patients.
authors.affiliation: Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM, Renal and Cardiovascular Epidemiology Team, Villejuif, France. natalia.alencar-de-pinho@inserm.fr.
authors.forename: Natalia
authors.identifier: 0000-0002-0438-6487
authors.initials: N
authors.lastname: Alencar de Pinho
authors.affiliation: Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM, Renal and Cardiovascular Epidemiology Team, Villejuif, France.|Division of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Coscas
authors.affiliation: Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM, Renal and Cardiovascular Epidemiology Team, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Lyon-Sud University Hospital, Pierre-Bénite, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Labeeuw
authors.affiliation: CHRU Nancy, Pôle S2R, Epidémiologie et Evaluations Cliniques, Nancy, France.|Inserm, CIC-1433 Epidémiologie Clinique, Nancy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ayav
authors.affiliation: Biomedicine Agency, Saint Denis, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.affiliation: Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM, Renal and Cardiovascular Epidemiology Team, Villejuif, France.|Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.affiliation: Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM, Renal and Cardiovascular Epidemiology Team, Villejuif, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D062905:Central Venous Catheters; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000379:methods*
keywords: Arteriovenous fistula; Catheter; Chronic hemodialysis; Epidemiology; Vascular access