2018 Annual Data Report - PowerPoint Presentation

Slide1

2018 Annual Data ReportVolume 2: End-Stage Renal Disease

Chapter 3:

Vascular Access

2

vol 2 Figure 3.1 Vascular access use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2005-2016

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating hemodialysis in 2005-2016. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

3

vol 2 Table 3.1 Vascular access used at hemodialysis initiation by patient characteristics from the ESRD Medical Evidence form (CMS 2728), 2016

AV fistulaAV graftCatheter with maturing fistulaCatheter with maturing graftCatheter onlyAll16.73.016.11.662.5Age0-217.10.99.70.182.222-4413.41.816.31.267.445-6416.92.817.21.661.465-7418.03.216.41.560.975+16.63.714.01.963.7SexMale18.32.316.61.361.5Female14.74.015.42.063.9Race     White17.32.415.71.463.2Black/African American14.74.516.72.361.8American Indian or Alaska Native18.52.619.90.858.2Asian19.83.416.81.658.3Other or Multiracial18.23.116.11.161.4Ethnicity     Hispanic14.71.916.21.266.1Non-Hispanic17.13.216.11.762Race/Ethnicity     Non-Hispanic White18.02.615.61.462.4Non-Hispanic Black/African American14.74.616.72.361.8Primary Cause of ESRD     Diabetes17.43.218.31.759.4Hypertension17.03.315.51.662.7Glomerulonephritis17.52.414.11.764.3Cystic kidney38.04.613.21.143Other urologic14.42.013.51.368.9Other cause9.01.810.11.477.7Unknown/Missing9.62.38.60.878.7Comorbidities     Diabetes16.53.117.41.761.3Congestive heart failure12.32.616.91.766.4Atherosclerotic heart disease16.13.117.51.761.6Cerebrovascular disease14.93.416.52.063.2Peripheral vascular disease13.92.818.11.863.4Hypertension17.33.116.51.661.5Other cardiac disease13.72.515.91.766.3

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

4

vol 2 Figure 3.2 Geographic variation in percentage of catheter-only use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2016

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Abbreviations: CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

5

vol 2 Figure 3.3 Geographic variation in percentage of AV fistula use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2016

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. AV fistula use includes not only AV fistulas, but also catheters with a maturing fistula. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

6

vol 2 Table 3.2 Distribution of type of vascular access in use among prevalent hemodialysis patients in 2017, from CROWNWeb data, May 2017

AV fistulaAV graftCatheterAll64.516.618.9Age0-2144.06.849.322-4466.213.620.245-6466.615.518.065-7463.917.418.775+60.919.419.7SexMale70.412.617.0Female56.721.921.4Race   White67.312.819.9Black/African American59.123.117.8American Indian or Alaska Native75.810.114.1Asian68.415.616.0Other or Multiracial62.312.924.8Ethnicity   Hispanic70.313.416.3Non-Hispanic63.317.319.4Race/Ethnicity   Non-Hispanic White65.812.621.6Non-Hispanic Black/African-American59.123.217.7Primary Cause of ESRDDiabetes65.116.218.7Hypertension64.517.418.1Glomerulonephritis66.416.816.8Cystic kidney70.614.315.1Other urologic62.915.521.6Other cause58.516.225.3Unknown/Missing59.615.824.6

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database.

CROWNWeb

data, catheter = any catheter use; fistula and graft use shown are without the use of a catheter. Abbreviations: AV, arteriovenous;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

7

vol 2 Figure 3.4 Geographic variation in percentage catheter use among prevalent hemodialysis patients by Health Service Area, from CROWNWeb data, May 2017

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Abbreviation:

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

8

vol 2 Figure 3.5 Geographic variation in percentage AV fistula use among prevalent hemodialysis patients by Health Service Area, from CROWNWeb data, May 2017

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

9

vol 2 Figure 3.6 Trends in vascular access type use among ESRD prevalent patients, 2003-2017

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database and Fistula First data. Fistula First data reported from July 2003 through April 2012,

CROWNWeb

data are reported from June 2012 through May 2017. Abbreviations: AV, arteriovenous;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

10

vol 2 Figure 3.7 Change in type of vascular access during the first year of dialysis among patients starting ESRD via hemodialysis in 2013 quarterly: (a) type of vascular access in use (cross-sectional), and (b) longitudinal changes in vascular access use and other outcomes, ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2017

2018 Annual Data Report

Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Data from January 1, 2014 to May 30, 2017: (a) Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. (b) ESRD patients initiating hemodialysis (N =104,102). Patients with a maturing AV fistula / AV graft with a catheter in place were classified as having a catheter. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; CROWNWeb, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

11

vol 2 Figure 3.7 Change in type of vascular access during the first year of dialysis among patients starting ESRD via hemodialysis in 2013 quarterly: (a) type of vascular access in use (cross-sectional), and (b) longitudinal changes in vascular access use and other outcomes, ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2017

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Data from January 1, 2014 to May 30, 2017: (a) Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. (b) ESRD patients initiating hemodialysis (N =104,102). Patients with a maturing AV fistula / AV graft with a catheter in place were classified as having a catheter. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; CROWNWeb, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

(b) Longitudinal changes in vascular access use and other outcomes

12

vol 2 Table 3.3 Cross-sectional distributions of vascular access use, quarterly during the first two years of hemodialysis, among patients new to hemodialysis in 2013, by age group, from the ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2017

Age Access typeTimeAt initiation3 months6 months9 months1 year18 months2 years0-21AV fistula6.212.032.440.947.553.055.0AV graft0.70.81.63.73.84.85.0Catheter93.087.266.055.348.742.240.122-44AV fistula13.921.444.158.466.072.174.1AV graft1.94.47.610.010.812.112.7Catheter84.374.148.331.723.215.913.245-64AV fistula16.624.545.159.466.271.973.9AV graft2.85.69.511.813.114.414.8Catheter80.669.945.428.820.713.711.265-74AV fistula18.426.245.458.664.969.671.5AV graft3.16.611.414.115.517.017.6Catheter78.567.243.327.319.513.410.975+AV fistula17.024.141.553.559.364.366.0AV graft3.48.914.918.019.720.721.0 Catheter79.666.943.628.521.015.013.0

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and

CROWNWeb

for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

13

vol 2 Table 3.4 Cross-sectional distributions of vascular access use, quarterly during the first two years of hemodialysis among patients new to hemodialysis in 2013, by race, from the ESRD Medical Evidence form (CMS-2728) and CROWNWeb, 2013-2017

Race/EthnicityAccess typeTimeAt initiation3 months6 months9 months1 year18 months2 yearsWhiteAV fistula17.425.645.959.766.472.074.0AV graft2.45.49.411.712.713.614.0Catheter80.369.044.828.620.914.412.0Black/African AmericanAV fistula15.321.439.351.958.263.265.1AV graft4.29.215.018.320.222.022.6Catheter80.569.445.829.721.614.912.3American Indian or Alaska NativeAV fistula16.025.953.867.875.179.479.8AV graft2.04.06.88.39.49.910.6Catheter81.970.139.423.915.510.79.6AsianAV fistula19.528.250.263.270.475.777.1AV graft3.07.010.612.413.114.515.1Catheter77.564.839.224.416.59.87.8Native Hawaiian or Pacific IslanderAV fistula17.421.943.359.267.273.277.4AV graft2.44.98.610.512.514.113.9Catheter80.273.348.130.320.412.78.8Other or MultiracialAV fistula14.520.040.760.365.171.471.1AV graft3.95.611.311.411.814.314.2Catheter81.674.448.028.323.114.314.7HispanicAV fistula14.022.143.759.166.372.875.4AV graft2.15.08.911.312.613.714.3Catheter84.072.847.429.621.113.410.4Non-HispanicAV fistula17.424.944.257.363.768.870.5AV graft3.16.811.414.115.516.817.3Catheter79.668.344.328.620.814.412.2Non-Hispanic WhiteAV fistula18.326.646.559.866.371.573.3AV graft2.55.59.511.812.813.713.9Catheter79.267.944.028.420.914.812.7Non-Hispanic Black/African AmericanAV fistula15.321.539.352.058.363.265.1AV graft4.29.215.018.420.222.022.6Catheter80.569.345.629.621.514.812.2

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and

CROWNWeb

for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

14

vol 2 Table 3.5 Cross-sectional distributions of vascular access use, quarterly during the first two years of hemodialysis among patients new to hemodialysis in 2013, by sex, from the ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2017

SexAccess typeTimeAt initiation3 months6 months9 months1 year18 months2 yearsMaleAV fistula18.327.750.064.070.675.577.2AV graft2.25.18.610.611.512.412.8Catheter79.467.241.425.517.912.110.0FemaleAV fistula14.820.036.249.055.561.363.4AV graft3.88.514.417.819.721.522.2Catheter81.471.549.533.224.817.214.4

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and

CROWNWeb

for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.

15

vol 2 Table 3.6 Odds ratios and 95% confidence intervals from logistic regression models of AV fistula use at hemodialysis initiation, and AV fistula or graft use at hemodialysis initiation, from the CMS 2728, 2016

2018 Annual Data Report Volume 2 ESRD, Chapter 3

PredictorsAV fistula use at initiation AV fistula or graft use at initiationOdds ratio95% confidence interval Odds ratio95% confidence intervalLower boundUpper bound Lower boundUpper boundPre-ESRD nephrology care       0 months0.050.050.06 0.070.060.07>0 - <6 months0.270.260.29 0.290.270.306 - 12 months0.610.590.64 0.630.600.65>12 monthsRef.   Ref  Unknown0.210.200.22 0.210.200.23Age 0-210.310.230.41 0.290.220.3822-440.850.800.91 0.800.750.8545-64Ref.   Ref.  65-740.980.941.02 1.000.971.0575+0.850.810.89 0.930.890.97Sex Female0.740.720.77 0.860.830.89Male Ref.   Ref.  Race       WhiteRef.   Ref.  Black/African American0.940.910.99 1.141.091.18American Indian or Alaska Native1.010.861.20 1.040.881.22Asian1.070.981.16 1.080.991.17Other or Multiracial0.970.841.13 0.980.851.13Ethnicity Hispanic0.970.921.03 0.940.891.00Non-HispanicRef.   Ref  Diabetes as cause of ESRD0.960.920.99 0.980.951.01Facility census < 20Ref.   Ref.  20-500.890.850.92 0.880.850.9151-1000.790.720.85 0.740.690.80101-2000.590.380.91 0.580.390.86>2000.430.250.74 0.360.220.60ESRD network (vs. average network)       1 CT, ME, MA, NH, RI, VT1.281.181.38 1.291.201.392 NY1.171.101.25 1.151.081.223 NJ, PR, VI0.770.710.84 0.820.760.894 DE, PA1.040.961.12 1.030.961.105 VA, WV, MD, DC0.980.911.05 0.990.921.056 GA, NC, SC0.890.840.94 0.860.820.917 FL0.710.660.76 0.710.670.768 AL, MS, TN0.960.891.03 0.970.911.049 IN, KY, OH0.890.840.95 0.890.840.9410 IL0.910.830.99 0.940.871.0211 MN, MI, ND, SD, WI0.900.840.96 0.890.840.9512 IA, KS, MO, NE0.860.780.93 0.830.770.9013 AR, LA, OK1.020.941.10 0.940.871.0114 TX0.730.690.78 0.730.690.7815 AZ, CO, NV, NM, UT, WY1.321.221.41 1.261.171.3416 AK, ID, MT, OR, WA1.391.271.51 1.421.311.5417 AS, GU, MP, HI, Northern CA1.421.321.52 1.571.471.6818 Southern CA1.181.111.26 1.151.081.22

Data Source: Special analyses, USRDS ESRD Database. For more on ESRD networks:

http://www.cms.gov/About-CMS/Agency-Information/

RegionalOffices

/RegionalMap.html

. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

16

vol 2 Table 3.7 Distribution of number of days between AV fistula placement and first successful use*, overall and by patient characteristics, for new AV fistulas created in 2014-2015 (excludes patients not yet ESRD when fistula was placed), from Medicare claims and CROWNWeb, 2014-2017

 Total AV fistula placementsPercentage of failed placementsNumber of days between AV fistula placement and first useAverageMedian25th percentile75th percentileOverall86,84838.912010873156Age      0-2134532.21231067614822-449,69835.41161046915045-6432,28437.21191067115665-7424,69739.41231127615975+19,82442.712110976156Race      White54,41537.912110975155Black/African American27,15442.012010870160American Indian or Alaska Native1,10931.612311378153Asian2,98032.811310467146Native Hawaiian or Pacific Islander90533.412611073172Other or Multiracial24138.211410344153Unknown4434.113912176196Ethnicity      Hispanic12,34033.811710573150Non-Hispanic73,95239.712110973157Race/Ethnicity      Non-Hispanic White42,40639.112211076157Non-Hispanic Black/African American26,65741.912010870159Sex      Male49,39334.211610571148Female37,45545.112811576169Primary Cause of ESRD      Diabetes40,72238.812311175160Hypertension25,98638.711910873155Glomerulonephritis7,62136.811310366148Cystic kidney1,48936.511310468148Other urologic1,25935.711910773156Other cause7,55442.511810773153Unknown cause221740.611910669155

2018 Annual Data Report Volume 2 ESRD, Chapter 3

Data Source: Special analyses, USRDS ESRD Database. *Fistulas placed between June 1, 2014 and May 31, 2016, with follow-up through May 2017; follow-up is censored at one year after fistula placement date; date of first use was the date the given access was first reported in

CROWNWeb

to be in use in a particular patient. Abbreviations: AV, arteriovenous;

CROWNWeb

, Consolidated Renal Operations in a Web-enabled Network; ESRD, end-stage renal disease.