Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Michelle M O'ShaughnessyWolfgang C Winkelmayer

Abstract

The type of vascular access used for hemodialysis affects patient morbidity and mortality. Whether vascular access types differ by glomerulonephritis (GN) subtype in the US hemodialysis population has not been investigated. Cross-sectional observational study. We identified all adult (aged ≥ 18 years) patients within the US Renal Data System who initiated hemodialysis therapy from July 2005 through December 2011 with a diagnosis of end-stage renal disease attributed to any of 4 primary (focal segmental glomerulosclerosis, immunoglobulin A nephropathy [reference group], membranous nephropathy, and membranoproliferative GN) or 2 secondary (lupus nephritis and vasculitis) GN subtypes. GN subtype. ORs with 95% CIs for arteriovenous fistula versus central venous catheter (CVC) use and for arteriovenous graft versus CVC use were computed using multinomial logistic regression, with adjustment for demographic, socioeconomic, comorbidity, and duration of nephrology care covariates. Among 29,015 patients, CVC use at initiation of hemodialysis therapy was substantially higher in patients with lupus nephritis (89.2%) or vasculitis (91.2%) compared with patients with primary GN subtypes (72.7%-79.8%). After adjustment and compared with pati...Continue Reading

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Citations

Dec 28, 2018·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Michael BoehmFranz Schaefer

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