Supplementary Material for: Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

<b><i>Background:</i></b> Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. <b><i>Methods:</i></b> The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. <b><i>Results:</i></b> The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. <b><i>Conclusion:</i></b> Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

<b><i>背景：</i></b> 慢性血液透析需通过动静脉内瘘（arteriovenous fistula, AVF）、人工合成动静脉移植物（prosthetic arteriovenous graft, AVG）或中心静脉导管（central venous catheter, CVC）建立血管通路。相较于人工动静脉移植物或中心静脉导管，动静脉内瘘因通畅性更优且成熟后干预率更低，被作为首选推荐方案；而人工动静脉移植物又因感染风险与死亡风险更低，优于中心静脉导管。本研究旨在评估动静脉内瘘与人工动静脉移植物在成熟、持续通路使用及废弃状态下的使用寿命。
<b><i>方法：</i></b> 本研究依托美国肾脏数据系统（United States Renal Data System, USRDS）、医疗保险理赔数据及CROWNWeb数据库识别血管通路置入情况。纳入标准为：2012年1月1日至2014年6月30日期间首次接受终末期肾病（end-stage renal disease, ESRD）诊疗、以医疗保险作为主要支付方且持续参保，并在终末期肾病发病后置入至少1个动静脉内瘘或人工动静脉移植物的患者。成熟定义为：在CROWNWeb数据库中记录到首次使用该血管通路进行血液透析。持续通路使用定义为：连续3个月使用该通路且未置入或更换中心静脉导管。置入后从未被使用的血管通路被判定为废弃通路。
<b><i>结果：</i></b> 本队列共纳入38035例动静脉内瘘置入病例与12789例人工动静脉移植物置入病例。其中69%的动静脉内瘘与72%的人工动静脉移植物实现成熟。52%的动静脉内瘘与51%的人工动静脉移植物达到持续通路使用标准。根据CROWNWeb数据库记录，四分之一的动静脉内瘘与14%的人工动静脉移植物未被使用即遭废弃。
<b><i>结论：</i></b> 尽管动静脉内瘘被视为血管通路的金标准，但仅有半数的动静脉内瘘与人工动静脉移植物置入病例实现了持续通路使用。美国肾脏数据系统数据库存在固有局限性，但可为血管通路的成熟、持续使用及废弃状态提供具有临床价值的参考见解。