Impacts of age, diabetes, gender, and access type on costs associated with vascular access among Chinese patients on hemodialysis

The role of hemodialysis access in intradialysis and interdialysis vital sign variabilities and the development of dialysis headache

To determine the relationship of hemodialysis access with vital sign variability and hemodialysis-related headache (HRH). Adult outpatients receiving maintenance hemodialysis (MHD) were prospectively recruited, and 12 consecutive dialysis sessions were monitored. Intradialysis (hour-to-hour) and interdialysis (dialysis day-to-day) vital sign variabilities were assessed via three metrics: the difference between the maximum and minimum values, average real variability (ARV), and residuals. Multivariate logistic regression analysis was used to explore the factors triggering HRH. A total of 91 Chinese MHD patients (60.4% male) aged 58.5 ± 17.2 years were included, with 59 patients using radiocephalic arteriovenous fistulas (RCAVFs) and 32 patients using tunneled cuffed catheters (TCCs) for dialysis. The median dialysis vintage was 26.8 (12.0-44.7) months. Compared with the RCAVF group, the TCC group had significantly greater urea reduction (71.1 ± 9.3% vs. 61.7 ± 10.5%, p < 0.001) and clearance (1.5 (1.2-1.8) vs. 1.1 (1.0-1.4), p < 0.001) rates, higher intradialysis pulse variability and lower intradialysis diastolic blood pressure variability. Some of interdialysis variability indexes in pulse, systolic blood pressure (SBP), and SpO2 were significantly greater in the TCC group than that in the RCAVF group. Age (OR = 0.880, 95% CI = 0.785-0.986, p = 0.028), TCC use (OR = 22.257, 95% CI = 1.190-416.399, p = 0.038), intradialysis SBP-ARV (OR = 2.768, 95% CI = 1.069-7.171, p = 0.036), and blood sodium level (OR = 0.400, 95% CI = 0.192-0.832, p = 0.014) were shown to be independent risk factors for HRH. In conclusion, the use of TCCs has multifaceted effects on intradialysis and interdialysis vital sign variabilities and is independently associated with an increased risk of HRH.

What are the reported procedural costs of vascular access surgery?

INTRODUCTION

Since the inception of arteriovenous grafts (AVG) as a novel technique, there has been greater emphasis on the assessment of outcomes rather than costs. Gross-costing methods over-simplify vascular access surgery and do not reflect the true costs of the service, preventing accurate cost-effectiveness analysis. The aim of this study is to assess the reporting of procedural costs of arteriovenous access creation in economic analyses of vascular access surgery, and to compare the reported costs of the two most performed procedures - arteriovenous fistula (AVF) and arteriovenous graft (AVG).

METHODS

This systematic review included studies reporting a per-procedure cost for AVF or AVG creation. Costs were adjusted from original to target price year using a Gross Domestic Product (GDP) deflator index and converted to 2021 US Dollars using conversion rates based on purchasing power parities.

RESULTS

The results demonstrate wide discrepancy in the reported procedural costs of arteriovenous access creation. Most of the data represents retrospectively observed costs rather than prospective data collected on an intention-to-treat basis. Charges are frequently presented in lieu of costs, and aggregated gross-costing methodology predominates rather than more accurate micro-costing.

CONCLUSION

Future micro-costing studies of vascular access surgery are essential to allow a greater understanding of cost-drivers and allow accurate cost-effectiveness analysis.