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Nephrol Dial Transplant. 2014 Oct;29(10):1956-64. doi: 10.1093/ndt/gfu253. Epub 2014 Jul 24.

Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry.

Author information

1
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
2
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium.
3
Austrian Dialysis and Transplant Registry, Kematen ad Krems, Austria.
4
French-Belgian ESRD Registry, Brussels, Belgium.
5
Department of Nephrology, University of Copenhagen Herlev, Copenhagen, Denmark.
6
University Clinic of Nephrology, Medical Faculty, University 'Sts. Cyril and Methodius', Skopje, FYR of Macedonia.
7
The Norwegian Renal Registry, Renal Unit, Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
8
Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.
9
Department of Nephrology, Hospital Juan Ramón Jiménez, Huelva, Spain.
10
Catalonian Registry of Renal Patients, Nephrology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
11
Swedish Renal Registry, Jönköping, Sweden Department of Internal Medicine, Hospital of Helsingborg, Helsingborg, Sweden.
12
Ninewells Hospital, Dundee,UK.
13
Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
14
Nephrology Section, Ghent University Hospital, Ghent, Belgium.
15
Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada.

Abstract

BACKGROUND:

Although arteriovenous fistulas (AVFs) are actively promoted, their use at the start of haemodialysis (HD) seems to be decreasing worldwide. In this paper, we describe recent trends in incidence and prevalence of vascular access types in Europe from 2005 to 2009 and their relationship with patient characteristics and survival.

METHODS:

Ten European renal registries participating in the ERA-EDTA Registry provided data on incidence (n = 13,044) and/or prevalence (n = 75,715) of vascular access types. We used logistic regression to assess which factors influence the likelihood to be treated with an AVF rather than another type.

RESULTS:

The use of AVFs at the start of HD showed a significant decreasing trend from 42% in 2005 to 32% in 2009 (P < 0.0001), while the use of central venous catheters (CVCs) increased from 58 to 68% (P < 0.0001). A similar evolution pattern was observed for the prevalence; use of AVFs decreased from 66 to 62% and use of CVCs increased from 28 to 32%. There was a large international variation in the use of the different vascular access types. Female patients [adjusted odds ratio: 0.84, 95% confidence interval (CI): 0.78-0.90] and those ≥80 years (0.77, 95% CI: 0.67-0.90) were least likely to start HD with an AVF.

CONCLUSION:

In Europe, there is a decreasing trend in the use of AVFs and an increasing trend in the use of CVCs at the start and after the start of HD. We cannot explain all between-country variations we found, and more research is needed to clarify how healthcare around vascular access is organized in Europe.

KEYWORDS:

AV fistula; catheter; haemodialysis; mortality; vascular access

PMID:
25061126
DOI:
10.1093/ndt/gfu253
[Indexed for MEDLINE]

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