TITLE：Arteriovenous Vascular Access-Related Procedural Burden Among Incident Hemodialysis Patients in the United States.
RATIONALE & OBJECTIVE：As the proportion of arteriovenous fistulae (AVF) compared to arteriovenous grafts (AVG) in the United States has increased, there has been a concurrent increase in interventions. We sought to explore AVF and AVG maturation and maintenance procedural burden in the first year of hemodialysis.
STUDY DESIGN：Observational cohort study.
SETTING & PARTICIPANTS：Patients initiating hemodialysis from July 1, 2012, to December 31, 2014 and having a first time AVF or AVG placement between dialysis initiation and 1 year were identified (N=73,027) using the United States Renal Data System (USRDS).
PREDICTORS：Patient characteristics.
OUTCOMES：Successful AVF/AVG use and intervention procedure burden.
ANALYTICAL APPROACH：For each group, we analyzed interventional procedure rates during maturation maintenance phases using Poisson regression. We used proportional rate modelling for covariate-adjusted analysis of interventional procedure rates during the maintenance phase.
RESULTS：During maturation phase, 13,989 of 57,275 (24.4%) patients in the AVF group required intervention, with therapeutic interventional requirements of 0.36 per person (pp). In the AVG group, 2,904 of 15,572 (18.4%) patients required intervention during maturation, with therapeutic interventional requirements of 0.28 pp. During maintenance phase, in the AVF group, 12,732 of 32,115 (39.6%) patients required intervention, with a therapeutic intervention rate of 0.93 per person-year (ppy). During maintenance phase, in the AVG group, 5,928 of 10,271 (57.7%) patients required intervention, with a therapeutic intervention rate of 1.87 ppy. For both phases, intervention rates for AVF tended to be higher on the East Coast, while those for AVG were more uniform geographically.
LIMITATIONS：This study relies on administrative data, with monthly recording of access use.
CONCLUSIONS：During maturation, interventions for both AVF and AVG were relatively common. Once successfully matured, AVF had lower maintenance interventional requirements. During maturation and maintenance phases, there were geographic variations in AVF intervention rates that warrant additional study.
SOURCE： Am J Kidney Dis 2021 Apr 12.
背景与目标：由于在美国，动静脉内瘘（AVF）与动静脉移植物（AVG）的比例增加，因此干预措施也同时增加。我们试图探讨血液透析第一年的AVF和AVG的成熟度以及维持手术的负担。
研究类型：观察性队列研究。
参加者及参与者：使用美国肾脏数据系统（USRDS）确定了从2012年7月1日至2014年12月31日开始进行血液透析，并在透析开始至1年之间首次进行AVF或AVG植入的患者（N = 73,027）。
预测指标：患者特征。
结果：成功使用AVF / AVG和干预程序负担。
分析方法：对于每个组，我们使用泊松回归分析分析了维持成熟阶段的介入手术率。在维护阶段，我们使用比例比率模型对干预程序比率进行协变量调整分析。
结果：在成熟阶段，AVF组的57,275名患者中有13,989名（24.4％）需要干预，而治疗性干预要求为每人（pp）0.36。在AVG组中，有15,572名患者中的2,904名（18.4％）在成熟期间需要干预，而治疗性干预要求为0.28 pp。在维持阶段，在AVF组中，有32,115名患者中的12,732名（39.6％）需要进行干预，并采用治疗性干预每人年0.93（ppy）的比率。在维持阶段，AVG组中有10,271名患者中的5,928名（57.7％）需要干预，治疗干预率为1.87 ppy。在这两个阶段，东海岸地区AVF的干预率都较高，而AVG地区的干预率在地理上更为统一。
局限性：这项研究依赖于管理数据，并每月记录访问使用情况。
结论：在成熟期间，对AVF和AVG的干预相对普遍。一旦成功成熟，AVF的维护干预要求就会降低。在成熟和维持阶段，AVF干预率存在地域差异，值得进一步研究。
启发：内瘘成熟困难比较常见，通过介入促成熟，有利于内瘘的成功使用。
