Arbor Research Collaborative for Health Researchers Add New Data to Research in Arteriovenous Fistula (Survival Among Incident Peritoneal Dialysis Versus Hemodialysis Patients Who Initiate With an Arteriovenous FistulaPlain-Language Summary)

2020 DEC 17 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Current study results on arteriovenous fistula have been published. According to news reporting from the Arbor Research Collaborative for Health by NewsRx journalists, research stated, “Rationale & Comparisons of outcomes between in-center hemodialysis (HD) and peritoneal dialysis (PD) are confounded by selection bias because PD patients are typically younger and healthier and may have received longer predialysis care. We compared first-year survival between what we hypothesized were clinically equivalent groups; namely, patients who initiate maintenance HD using an arteriovenous fistula (AVF) and those selecting PD as their initial modality.”

Funders for this research include National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health.

The news reporters obtained a quote from the research from Arbor Research Collaborative for Health: “Observational, registry-based, retrospective cohort study. Setting & Participants: US Renal Data System data for 5 annual cohorts (2010-2014; n = 130,324) of incident HD with an AVF and incident PD patients. Exposures and Predictors: Exposure was more than 1 day receiving PD or more than 1 day receiving HD with an AVF. Time at risk for both cohorts was determined for 12 consecutive 30-day segments, censoring for transplantation, loss to follow-up, or end of time. Predictors included patient-level characteristics obtained from Centers for Medicare & Medicaid Services 2728 Form and other data sources. Patient survival. Analytical Approach: Unadjusted and multivariable risk-adjusted HRs for death of HD versus PD patients, averaged over 2010 to 2014, were calculated. The HD cohort’s average unadjusted mortality rate was consistently higher than for the PD cohort. The HR of HD versus PD was 1.25 (95% CI, 1.20-1.30) in the unadjusted model and 0.84 (95% CI, 0.80-0.87) in the adjusted model. However, multivariable risk-adjusted analyses showed the HR of HD versus PD for the first 90 days was 1.06 (95% CI, 0.98-1.14), decreasing to 0.74 (95% CI, 0.68-0.80) in the 270- to 360-day period. Limitations: Residual confounding due to selection bias inherent in dialysis modality choice and the observational study design. Form 2728 provides baseline data at dialysis incidence alone, but not over time.”

According to the news editors, the research concluded: “US patients receiving HD with an AVF appear to have a survival advantage over PD patients after 90 days of dialysis initiation after accounting for patient characteristics. These findings have implications in the choice of initial dialysis modality and vascular access for patients.”

For more information on this research see: Survival Among Incident Peritoneal Dialysis Versus Hemodialysis Patients Who Initiate With an Arteriovenous FistulaPlain-Language Summary. Kidney Medicine, 2020,2(6):732-741.e1. The publisher for Kidney Medicine is Elsevier.

A free version of this journal article is available at https://doi.org/10.1016/j.xkme.2020.09.002.

Our news journalists report that more information may be obtained by contacting Purna Mukhopadhyay, Arbor Research Collaborative for Health, Ann Arbor, MI. Additional authors for this research include Kenneth J. Woodside, Douglas E. Schaubel, Kaitlyn Repeck, Keith McCullough, Vahakn B. Shahinian, Ronald L. Pisoni, Rajiv Saran.

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