Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

• Published in: Journal of the American Society of Nephrology Vol. 21; no. 9; pp. 1571 - 1577
• Main Authors: HURST, Frank P, ABBOTT, Kevin C, RAJ, Dominic, KRISHNAN, Mahesh, PALANT, Carlos E, AGODOA, Lawrence Y, JINDAL, Rahul M
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.09.2010
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteriovenous Shunt, Surgical - statistics & numerical data; Biological and medical sciences; Clinical Epidemiology; Cross-Sectional Studies; Delivery of Health Care; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Insurance, Health; Intensive care medicine; Male; Medical sciences; Medicare; Middle Aged; Nephrology. Urinary tract diseases; Renal Dialysis; United States; United States; Human; Nephrology; Hemodialysis; Cardiovascular disease; Organism defense; Congenital disease; Urology; Venous disease; Incidence; Arterial disease; Vascular disease; Extrarenal dialysis; Arteriovenous aneurysm; Facility; Veteran; Arteriovenous malformation
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2010010025

A higher proportion of patients initiate hemodialysis (HD) with an arteriovenous fistula (AVF) in countries with universal health care systems compared with the United States. Because federally sponsored national health care organizations in the United States, such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD), are similar to a universal health care model, we studied AVF use within these organizations. We used the US Renal Data System database to perform a cross-sectional analysis of patients who initiated HD between 2005 and 2006. Patients who received predialysis nephrology care had 10-fold greater odds of initiating dialysis with an AVF (adjusted odds ratio [aOR] 10.3; 95% confidence interval [CI] 9.6 to 11.1). DVA/DoD insurance also independently associated with initiating HD with an AVF (aOR 1.4; 95% CI 1.2 to 1.5). Fewer patients initiated HD at a DoD facility, but these patients were also approximately twice as likely to use an AVF (aOR 2.3; 95% CI 1.2 to 4.6). In conclusion, patients in DVA/DoD systems are significantly more likely to use an AVF at initiation of HD than patients with other insurance types, including Medicare. Further study of these federal systems may identify practices that could improve processes of care across health care systems to increase the number of patients who initiate HD with an AVF.