To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period.
Annual reports from the Catalan Transplant Organization, ...Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed.
A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067).
Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.
To report the current clinical applications and trends of scleral and amniotic membrane use in ophthalmology. Review of annual reports from the Catalan Transplant Organization (OCATT), on scleral ...patch and amniotic membrane eye indications in Catalonia region (Spain) over a 6-year period from 2013 to 2018. A total of 874 scleral and 1665 amniotic membranes patches were implanted, from January 2013 to December 2018. The most frequent indication over the 6-year period for scleral patch was glaucoma surgery (77.5%), eyelid reconstruction (5.2%) and corneal or scleral ulcer (5%). Regarding amniotic membrane, corneal ulcer (26.9%), conjunctival reconstruction (23.8%) and corneal epithelial defect (22.7%) were the most common indications. During the study period, an increasing trend was found on sclera patches for eyelid reconstruction (
p
= 0.0032) and amniotic membrane for inflammation management (
p
= 0.0198). Glaucoma surgery and corneal ulcers have represented the top indications for scleral patch and amniotic membrane use, over the period, respectively. A significant trend has also been found towards eyelid reconstruction using scleral patches and amniotic membrane for anterior segment inflammation management. This evolving scenario in tissue use for ocular surgery has to be taken into consideration, especially regarding eye banks facing current and futures changes in tissue preservation, storage and indications.
Introduction Biovigilance (BV) systems aim to improve the quality and safety of tissues and organs for transplantation. This study describes the Catalan BV system and analyzes its utility. Methods It ...is a retrospective analysis of notifications on serious adverse events (SAEs) and reactions (SARs) since the implementation of the BV system (2008 for tissues and 2016 for organs) until 2020. Variables are presented to describe the most common critical steps of the pathway and complications associated with the quality and safety of tissues and organs. Results A total of 154 and 125 notifications were reported to the Tissue and the Organ BV systems, respectively. Most SAEs were related to unexpected donor diseases and implemented actions were assured on those deemed preventable. Regarding SARs, donor-transmitted infections and malignancies (only organs) were the most common, followed by graft failure (tissues) and process-related (organs). The incidence of SAEs and SARs related to tissue was 3.44‰ and 0.22‰, respectively. The corresponding figures for organs were 31.48‰ and 8.8‰, respectively. Discussion The analysis of the notifications to the Catalan BV systems has provided useful information about existing risks associated with the quality and safety of tissues and organs, and enabled the implementation of actions targeted to diminish risks and mitigate damage.
Abstract Background Gender disparities of some aspects of vascular access (VA) for hemodialysis (HD) have been reported. Aim To analyze the VA profile of prevalent HD patients (pts) according to ...gender in Catalonia Method Data from the Catalan Renal Registry of end-stage kidney disease (ESKD) pts over 18 years of age treated by HD on 31 December were examined from 1997 to 2021. Results The total cumulative number of follow-ups registered for prevalent ESKD pts treated by HD was 95 575 out of 25 130 pts; we have VA information for most of the follow-ups (93.1%, 88 980/95 575). The number of prevalent HD pts increased from 3104 in 1997 to 4270 in 2021. The characteristics of prevalent HD pts in 2021 (n = 4270) were different for male (n = 2731) vs female (n = 1539) regarding mean age (69.1 ± 14.6 vs 70.9 ± 14.3 years), age bracket >74 years (42.4% vs 48.3%), median time on HD 24.0 (9.8−48.2) vs 27.6 (10.5−59.1) , aetiology of ESKD as polycystic kidney disease (4.4% vs 7.2%), normal functional status (38.0% vs 28.4%), cardiovascular disease (76.3% vs 71.1%) and obesity rate (body mass index BMI>30 kg/m2: 17.4% vs 27.2%) (for all comparisons, p < 0.001). The distribution of the VA used for performing HD in 2021 was also different in men vs women: fistula AVF (58.1%, n = 1465 vs 45.6%, n = 657), graft (1.8%, n = 45 vs 3.5%, n = 51) and tunnelled catheter (35.8%, n = 903 vs 45.8%, n = 660) (for all comparisons, p < 0.001) ; there were no differences for non-tunnelled catheter (4.3%, n = 107 vs 5.0%, n = 72) (p = 0.15). In addition, the type of AVF was different in men vs women: radiocephalic AVF (53.9% vs 40.9%) and brachial artery-based AVF (46.1% vs 59.1%) (p < 0.001). The percentage of pts who required at least one hospital admission or outpatient procedure for any VA pathology in 2021 was similar when comparing men 7.3% (n = 180) and 19.6% (n = 456), respectively and women 8.6% (n = 122) and 19.3% (260), respectively (p = 0.34 and p = 0.38, respectively). Regarding the total cumulative number of VA used for HD, the percentage of pts who used only one VA was higher for men (50.4%, n = 1265) than women (47.1%, n = 663); however, this difference is reversed when the percentage of pts who used ≥4 VA was calculated: 11.5% (n = 289) vs 14.4% (n = 203) (for all comparisons, p = 0.001). The percentage of pts who have been dialyzed through AVF at some point over time was higher for men (69.2%, n = 1889) than women (62.6%, n = 964) (p < 0.001) The probability of performing HD through AVF in 2021was independently associated with male gender (odds ratio 1.58 95% confidence interval: 1.36–1.82, p < 0.001) after adjusting for age, time on HD, primary kidney disease, cardiovascular disease, functional status and BMI (multivariate logistic regression analysis). The percentage of both men and women on HD through AVF decreased progressively from 1997 (89.1% and 81.3%, respectively) to 2021 (58.1% and 45.6%, respectively) (for both comparisons, p < 0.001). The percentage of prevalent men on HD with AVF was always higher over time than that of women from 1997 (89.1% vs 58.1%) to 2021 (81.3% vs 45.6%) (for both comparisons, p < 0.001). Conclusions 1) AVF was the main type of VA used for prevalent men on HD, but AVF and tunnelled catheter shared this ranking in women. 2) Male gender was an independent factor associated with a 58% greater probability of performing HD through AVF than female. 3) The percentage of prevalent HD pts dialyzed through AVF progressively decreased over time in both sexes but it was always higher in men than women. 4) The type of AVF mainly used was different depending on gender: radiocephalic AVF for men and brachial artery-based AVF for women.
Abstract
Background
Gender disparities of some aspects of vascular access (VA) for haemodialysis (HD) have been reported. Aims: To analyze the VA profile of incident HD patients (pts) depending on ...gender in Catalonia.
Method
Data from the Catalan Renal Registry of 22,859 end-stage kidney disease (ESKD) pts older than 18 years of age starting HD therapy was examined over a 24-year period (1997-2021).
Results
Male (n = 14,921) and female (n = 8038) characteristics were different regarding age (66.2±14.2 vs 67.2±14.4 years), normal functional status (40.2% vs 33.2%), cardiovascular disease (58.3% vs 48%) and obesity rate (body mass index BMI>30 kg/m2: 16.1% vs 25.7%) (for all comparisons, p<0.001). The distribution of the first VA used for starting HD was different in men vs women: fistulae AVF (46.1%, n = 6308 vs 41.3%, n = 3088), graft AVG (0.8%, n = 108 vs 1.7%%, n = 129) and tunnelled catheter (20.4%, n = 2789 vs 23%, n = 1719) (for all comparisons, p<0.001); without differences for non-tunnelled catheter (32.8%, n = 4488 vs 34%, n = 2537) (p = 0.083). Percentage of both men and women starting HD by AVF: it decreased progressively from 1997 (53.4% and 41.8%, respectively) to 2021 (37.3% and 33.2%, respectively) (p<0.001 and p = 0.032, respectively). Percentage of incident men with AVF: it was higher than women in 1997 (53.4% vs 41.8%, p = 0.002) but this difference decreased over time and was no longer significant in 2021 (37.3% vs 33.2%, p = 0.22). Probability of starting HD by AVF: it was independently associated with male gender (odds ratio 1.32 95% confidence interval: 1.23–1.41, p<0.001) after adjusting for age, primary kidney disease, functional status, BMI, cardiovascular disease and ESKD presentation (multivariate logistic regression analysis). By using a competing risk model, the hazard ratio (HR) for receiving a kidney graft (KG) within five years from starting HD, depending on the first VA used to start HD (AVF vs catheter), was: 1.82 (95% CI: 1.69-1.95, p<0.001) for men and 2.32 (95% CI: 2.11-2.55, p<0.001) for women. In comparison with men that started HD by AVF, the HR of women for receiving a KG within five years from starting HD by AVF was 1.12 (95% CI: 1.04-1.21, p = 0.002). In comparison with women that started HD by catheter, the HR of men for receiving a KG within five years from starting HD by catheter was 1.13 (95% CI: 1.03-1.24, p = 0.007). The HR of death within five years from starting HD, depending on the first VA used to start HD (catheter vs AVF), was: 1.55 (95% CI: 1.47-1.63, p<0.001) for men and 1.95 (95% CI: 1.81-2.11, p<0.001) for women. In comparison with men that started HD by catheter, the HR of death for women within five years from starting HD by catheter was 1.01 (95% CI: 0.95-1.06, p = 0.81). In comparison with women that started HD by AVF, the HR of death for men within five years from starting HD by AVF was 1.26 (95% CI: 1.17-1.36, p<0.001).
Conclusions
1) Although AVF was the main type of VA used for starting HD in both sexes, the percentage of AVF was significantly lower in women at the expense of AVG and tunnelled catheter. 2) Male gender was an independent factor associated with a 32% greater probability of starting HD by AVF than female. 3) Women initiating HD by AVF were more likely to receive a KG over time than men with an AVF. 4) Men and women shared the same probability to die over time after starting HD with a catheter. 5) Men starting HD by AVF were more likely to die over time than women with an AVF. 6) Regardless of gender, initiating HD by catheter was associated with a lower probability of receiving a KG and a higher probability of dying over time compared to AVF.
Abstract
BACKGROUND AND AIMS
End-stage kidney disease (ESKD) due to diabetes mellitus (DM) is the main known cause of kidney replacement therapy initiation in Catalonia.
To analyse the use and ...results of vascular access (VA) in incident haemodialysis (HD) patients (pts) with DM types 1 (DM-1) and 2 (DM-2) over time in Catalonia
METHOD
Data from the Catalan Renal Registry of 14 954 ESKD pts ˃18 years of age starting HD therapy were examined for a 23-year period.
RESULTS
The characteristics of DM-2 pts (n = 4242) were different compared with DM-1 pts (n = 456) or non-DM pts (n = 10 256) regarding age (69.0 ± 9.8 versus 50.5 ± 14.5 versus 64.2 ± 15.3 years), cardiovascular disease (76.7% versus 60.3% versus 46.5%), overweight (body mass index ≥ 25 kg/m2: 68.4% versus 44.4% versus 50.4%) and statin use (52% versus 41.1% versus 33.8%) (for all comparisons, P < 0.001).
Regarding the first VA used for starting HD, no differences were found in the percentage of fistulae AVF (44.7% versus 45.4% versus 46.2%, P = 0.27) but the distribution of tunnelled (40.8% versus 36.5% versus 34.7%) and non-tunnelled (59.2% versus 63.5% versus 65.3%) catheter was significant different in DM-2 pts (P < 0.001). Compared to non-DM pts (reference), the odds ratio for starting HD though an AVF, by using an adjusted multivariate logistic regression analysis, was 0.88 95% confidence interval (95% CI): 0.67–1.15, P = 0.35) and 0.90 (95% CI: 0.81–0.99, P = 0.04) for DM-1 and DM-2 pts, respectively.
By using a multivariate competing risk model, the hazard ratio (HR) of receiving a kidney graft (KG) within 5 years from starting HD, depending on the first VA used to start HD (AVF versus catheter), was: 2.14 (95% CI: 1.98–2.30, P < 0.001) for non-DM pts, 2.32 (95% CI: 1.63–3.30, P < 0.001) for DM-1 pts and 1.95 (95% CI: 1.65–2.30, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of receiving a KG within 5 years from starting HD though an AVF was 1.02 (95% CI: 0.76–1.37, P = 0.85) for DM-1 pts and 0.46 (95% CI: 0.40–0.53, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by catheter (reference), the HR of receiving a KG within 5 years from starting HD through a catheter was 1.11 (95% CI: 0.90–1.38, P = 0.29) for DM-1 pts and 0.42 (95% CI: 0.38–0.47, P < 0.001) for DM-2 pts.
The HR of pts’ survival within 5 years from starting HD, by applying a multivariate competing risk model depending on the first VA used to start HD (AVF versus catheter), was: 1.88 (95% CI: 1.76–2.01, P < 0.001) for non-DM pts, 1.58 (95% CI: 1.17–2.15, P = 0.003) for DM-1 pts and 1.54 (95% CI: 1.41–1.68, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of death within 5 years from starting HD through an AVF was 1.02 (95% CI: 0.83–1.24, P = 0.81) for DM-1 pts and 1.32 (95% CI: 1.23–1.41, P < 0.001) for DM-2 pts. Compared with non-DM pts starting HD with catheter (reference), the HR of death within 5 years from starting HD through a catheter was 1.22 (95% CI: 0.95–1.56, P = 0.12) for DM-1 pts and 1.70 (95% CI: 1.55–1.85, P < 0.001) for DM-2 pts.
CONCLUSIONS
i) The VA profile of incident DM-2 pts was different compared with DM-1 and non-DM pts due to the different types of catheter used for starting HD. ii) DM-2 pts showed an 11% lower probability of initiating HD through an AVF compared with non-DM pts. iii) Incident DM-1 pts with AVF and DM-2 pts with catheter showed the maximum and minimum probability to receive a KG within 5 years from starting HD, respectively. iv) Incident DM-2 pts with catheter and non-DM pts with AVF showed the maximum and minimum risk of dying within 5 years from starting HD, respectively.
Las variaciones en la utilización de servicios de salud pueden definirse como variaciones sistemáticas de las tasas ajustadas para ciertos niveles de agregación de la población. Analizamos el ...tratamiento sustitutivo renal (TSR) e identificamos la posible variabilidad en Cataluña entre 2002 y 2012.
Estudio ecológico por áreas de salud con datos del registro de enfermos renales de Cataluña. Presentamos tasas de incidencia, incidencia estandarizada y prevalencia. Variabilidad calculada mediante estadarización directa e indirecta.
Desde 2002 hasta el 31/12/2012, 10.784 pacientes iniciaron TSR en Cataluña: 9.238 mediante hemodiálisis (HD) (50 tratamientos/100.000 habitantes 2010/2012), 1.076 diálisis peritoneal (DP) (8,2 tratamientos/100.000 hab. 2010/2012) y 470 recibieron un trasplante renal (TR) anticipado (4,4 tratamientos/100.000 hab. 2010/2012). Durante 10 años, la tasa de incidencia acumulada de HD ha descendido (7%) y las tasas de incidencia de DP y TR han aumentado (63 y 177%); ambas son más elevadas en pacientes jóvenes (<45 años). Un total de 4.750 pacientes recibieron en ese periodo un TR; el 49% con edad de 45 a 65 años. No detectamos variabilidad entre áreas en HD (RV5-95=1,3; empírico de Bayes EB ∼ 0), ni tampoco en la tasa de prevalencia en TR (RV5-95=1,4; EB ∼ 0). Detectamos variabilidad significativa entre áreas geográficas en la indicación de DP, en las comarcas de la provincia de Lérida, donde el número de casos observados era superior a los esperados (RV5-95=4,01; EB=0,08).
Hay un notable incremento en la indicación de DP y TR anticipado, aunque la DP sigue infrautilizada considerando las recomendaciones internacionales. No hemos encontrado variación territorial en la indicación de HD y los casos con TR, pero sí en la indicación de DP: el área de Lérida es la que presenta unas tasas por encima del resto de las áreas. Para reducir la variabilidad territorial en DP incrementando la indicación de esta técnica en el resto de las comarcas, proponemos 3 actuaciones: desarrollo de herramientas de decisión en TSR compartidas, potenciación de formación específica en DP de los profesionales y promoción de la DP a través de sistemas de reembolso suplementarios.
Variations in the use of healthcare services can be defined as systematic variations of adjusted rates for certain aggregation levels of the population. The study analyses how renal replacement therapy (RRT) is used, identifying RRT variability in Catalonia from 2002 to 2012.
Ecological study by health area using data from the Catalan renal registry. We present incident rates, standardised incidence ratios and prevalence, while variability was calculated through direct and indirect standardisation methods.
From 2002 until 31/12/2012, 10,784 patients initiated RRT in Catalonia: 9,238 on haemodialysis (HD) (50 treatments per 100,000 people 2010/2012), 1,076 on peritoneal dialysis (PD) (8.2 treatments per 100,000 people 2010/2012) and 470 received an early kidney transplant (KT) (4.4 treatments per 100,000 people 2010/2012). Over the 10 years, the HD cumulative incidence rate fell (7%), while the PD and KT incidence rates increased (63% and 177%, respectively); both are higher in young patients (<45 years). 4,750 patients received a kidney transplant in this period, 49% of which were aged between 45 and 65 years. There were no significant differences in variability in HD (RV5-95=1.3; Empirical Bayes EB∼ 0), or in the prevalence of KT (RV5-95=1.4; EB ∼ 0). Nevertheless, we found significant geographical variability in PD; notably in the districts of the province of Lérida, where the number of cases observed was greater than expected (RV5-95=4.01; EB=0.08).
Although there was a notable rise in PD and early KT incidence rates, PD is still underused when compared to international recommendations. No territorial variability was found for HD or KT, but the use of PD was found to be higher in Lérida than in other areas. To reduce PD territorial variability and increase the uptake of this technique in the other regions, we propose 3initiatives: The development of RRT support tools for shared decision-making, the encouragement of specific PD professional training and the promotion of PD through complementary reimbursement systems.
Abstract
Background
Kidney transplantation (KT) is considered to be the best option of renal replacement therapy (RRT) for most end-stage renal disease (ESRD) patients (pts). Furthermore, ...arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most hemodialysis (HD) pts.
Aims
To analyze the effect of KT rate on the AVF rate in prevalent HD pts. In addition, the likelihood of receiving a kidney graft (KG) over time according to the first VA used to start HD program was also evaluated
Method
Data from the Catalan Registry of ESRD pts treated with either KT or HD were examined for a 20-year period
Results
The functioning KG rate increased progressively from 40.5% (n=2211) in 1997 to 57.0% (n=6149) in 2017 and, conversely, the AVF rate in prevalent HD patients decreased progressively from 86.0% (n=2609) to 63.2% (n=2546) during the same period (for both comparisons, p < 0.001).
The characteristics of all prevalent HD pts dialyzed in 1997 (n=3104) vs 2017 (n=4205) were different regarding age 62.6±15.3 vs 70.3±14.2 yr, diabetic nephropathy (DN) 13.2% vs 21.8% and cardiovascular disease (CD) 67.6% vs 75.8% (for all comparisons, p<0.001). On December 31, 2017 (maximum KT rate), the characteristics of KG recipients were different compared with prevalent HD pts dialyzed through either an AVF or a tunneled catheter (n=1145): age 57.4±14.5 vs 69.9±13.8 vs 72.0±14.6 yr, DN 9.5% vs 21.7% vs 22.5%, CD 38.6% vs 74.3% vs 83.7% (for all comparisons, p<0.001).
By analyzing the likelihood of prevalent pts performing HD through an AVF, we saw it was lower in pts with DN (OR: 0.86; 95% CI: 0.79-0.94, p=0.001) and it decreased progressively as they got older (reference >74 yr): <44 yr (OR:1.55, 95% CI: 1.41-1.70, p<0.001), 45-64 yr (OR: 1.47, 95% CI: 1.38-1.56, p<0.001) and 65-74 yr (OR: 1.22, 95% CI: 1.17-1.28, p<0.001). This probability was higher in males (OR: 1.84, 95% CI: 1.73-1.95, p<0.001), pts with polycystic kidney disease (OR: 1.54, 95% CI: 1.35-1.77, p<0.001) and pts without CD (OR: 1.32; 95% CI: 1.27-1.38, p<0.001) and it increased according to the time on RRT (reference < 1 month): >12 m (OR: 2.39, 95% CI: 2.17-2.64, p<0.001). In addition, this likelihood decreased progressively as the percentage of patients with a functioning KG increased (reference >55%): 40-45% (OR: 3.26, 95% CI: 3.05-3.48, p<0.001), 45-50% (OR: 1.82, 95% CI: 1.73-1.92, p<0.001) and 50-55% (OR: 1.27, 95% CI: 1.21-1.33, p<0.001).
The rate of prevalent HD pts waitlisted for KT and dialyzed through AVF decreased progressively from 94.5% (639/676, 1997) to 77.9% (491/630, 2017). In parallel, but always remaining at a lower level, the rate of prevalent HD patients not waitlisted for KT and dialyzed through AVF also decreased progressively from 83.6% (1970/2357) to 60.5% (2055/3399) during the same period (for all comparisons, p<0.001). Considering the prevalent HD pts during the period 2014-2017 (n=4029), significant differences were observed between HD pts waitlisted (n=630, 15.6%) and not-waitlisted (n=3399, 84.4%) for KT regarding age (58.2±12.9 vs 72.8±13.1 yr), DN (16.2% vs 23.0%), CD (59.5% vs 80.5%) and distribution of AVF (77.9% vs 60.5%) or tunneled catheter (16.5% vs 30.6%) (for all comparisons, p<0.001).
During the period 2012-2014, incident pts starting HD through an AVF (n=1026) had a significant higher likelihood of receiving a KG over time (HR: 1.68, 95% CI: 1.41-2.00, p<0.001) in comparison to pts who initiated HD through a catheter (n=1408).
Conclusion
1) The fall of prevalent HD pts with AVF over time could be associated with a progressive worsening of their clinical profiles along with the increasing rate of KG recipients. 2) In addition to some demographic and clinical characteristics of prevalent HD pts, the annual KT rate was also a determining factor in their AVF rate. 3) Starting HD program through an AVF was independently associated with a greater likelihood of receiving a KG over time as compared to starting HD through a catheter.
Background:
Kidney transplantation (KT) is considered to be the best kidney replacement therapy (KRT) option for most end-stage kidney disease (ESKD) patients. Arteriovenous fistula (AVF) is ...considered to be the best vascular access (VA) for most haemodialysis (HD) patients. In this study, we investigated the effect of KT activity on AVF use in prevalent HD patients. The probability of receiving a kidney graft (KTx) over time, depending on the first VA used to start the HD program, was also evaluated.
Methods:
Data from the Catalan Registry of prevalent patients on KRT by either KT or HD were examined over a 20-year period (1997–2017).
Results:
The percentage of prevalent ESKD patients with a functioning KTx increased from 40.5% in 1997 to 57.0% in 2017 and, conversely, the percentage of AVF utilisation in HD patients decreased from 86.0% to 63.2% during the same period (for both comparisons, p < 0.001). This inverse relationship was also demonstrated in other countries and regions worldwide by performing a simple linear regression analysis (R2 = 0.4974, p = 0.002). The probability of prevalent patients dialysed through an AVF in Catalonia was independently associated with the percentage of functioning KTx among KRT population, after adjusting by age, gender, primary kidney disease, time on KRT, cardiovascular disease and type of HD Unit. Incident patients starting HD through an AVF had a significantly higher probability of receiving a KTx over time in comparison to patients who initiated HD through a catheter (hazard ratio 1.68 95% confidence interval: 1.41–2.00, p < 0.001).
Conclusions
In addition to some demographical and clinical characteristics of patients and type of HD Unit, KT activity can be a determining factor in AVF use in prevalent HD patients. Starting an HD programme through an AVF is independently associated with a greater probability of receiving a KTx as compared to starting HD through a catheter.
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