The Rate of Procedures Required to Maintain Hemodialysis Vascular Access

Background: Patients and clinicians prioritize the need for procedures to maintain hemodialysis vascular access as a core research outcome. The lack of procedural data in population datasets has limited certainty about the frequency of procedural events. Methods: This is a national linkage analysis of registry and administrative health data. We included all patients who started kidney replacement therapy between 2004 through 2021 in New Zealand, including data from two years prior to two years after hemodialysis commencement. The incidence rate of vascular access procedures per patient year was calculated and a multivariate flexible parametric model used to estimate associations with demographic and clinical variables. Results: In 7725 patients the average rate of vascular access procedures was 0.71 (95% CI 0.70–0.72) procedures per patient-year, median 2 (quartiles 1,3) procedures. The hazard of procedures associated with sex (adjusted hazard ratio (HR) female versus male 1.09; 95% CI 1.05, 1.13) and body mass index (HR 1.17; 95% CI 1.10, 1.24 BMI>35 kg/m 2 versus 18.5–24.9). Patients in most recent treatment periods experienced lower procedural hazard (HR 0.77; 95% CI 0.73, 0.81 in 2017–2021 compared to 2002–2006), and the hazard varied among treating centers. Primary central venous catheter was associated with an increased procedural hazard (HR 1.34, 95% CI 1.28, 1.40) compared to primary arteriovenous fistula or graft. Conclusions: Half of adults underwent two or fewer hemodialysis vascular access procedures in the four-year period before and after hemodialysis commencement. Procedural rates differed by sex, body mass, treatment period and treatment center and were higher in adults with a primary central venous catheter.