MO791: Vascular Access of Incident Hemodialysis Patients with Diabetes Mellitus in Catalonia: Analysis of Data from the Catalan Renal Registry (1997–2020)
Authors: Roca-Tey Ramon , Cokas Jordi , Tort Jaume 
Published: May 2022

BACKGROUND AND AIMS

End-stage kidney disease (ESKD) due to diabetes mellitus (DM) is the main known cause of kidney replacement therapy initiation in Catalonia.

To analyse the use and results of vascular access (VA) in incident haemodialysis (HD) patients (pts) with DM types 1 (DM-1) and 2 (DM-2) over time in Catalonia

METHOD

Data from the Catalan Renal Registry of 14 954 ESKD pts ˃18 years of age starting HD therapy were examined for a 23-year period.

RESULTS

The characteristics of DM-2 pts (n = 4242) were different compared with DM-1 pts (n = 456) or non-DM pts (n = 10 256) regarding age (69.0 ± 9.8 versus 50.5 ± 14.5 versus 64.2 ± 15.3 years), cardiovascular disease (76.7% versus 60.3% versus 46.5%), overweight (body mass index ≥ 25 kg/m2: 68.4% versus 44.4% versus 50.4%) and statin use (52% versus 41.1% versus 33.8%) (for all comparisons, P &lt; 0.001).

Regarding the first VA used for starting HD, no differences were found in the percentage of fistulae AVF (44.7% versus 45.4% versus 46.2%, P = 0.27) but the distribution of tunnelled (40.8% versus 36.5% versus 34.7%) and non-tunnelled (59.2% versus 63.5% versus 65.3%) catheter was significant different in DM-2 pts (P &lt; 0.001). Compared to non-DM pts (reference), the odds ratio for starting HD though an AVF, by using an adjusted multivariate logistic regression analysis, was 0.88 [95% confidence interval (95% CI): 0.67–1.15, P = 0.35) and 0.90 (95% CI: 0.81–0.99, P = 0.04) for DM-1 and DM-2 pts, respectively.

By using a multivariate competing risk model, the hazard ratio (HR) of receiving a kidney graft (KG) within 5 years from starting HD, depending on the first VA used to start HD (AVF versus catheter), was: 2.14 (95% CI: 1.98–2.30, P &lt; 0.001) for non-DM pts, 2.32 (95% CI: 1.63–3.30, P &lt; 0.001) for DM-1 pts and 1.95 (95% CI: 1.65–2.30, P &lt; 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of receiving a KG within 5 years from starting HD though an AVF was 1.02 (95% CI: 0.76–1.37, P = 0.85) for DM-1 pts and 0.46 (95% CI: 0.40–0.53, P &lt; 0.001) for DM-2 pts. Compared with non-DM pts starting HD by catheter (reference), the HR of receiving a KG within 5 years from starting HD through a catheter was 1.11 (95% CI: 0.90–1.38, P = 0.29) for DM-1 pts and 0.42 (95% CI: 0.38–0.47, P &lt; 0.001) for DM-2 pts.

The HR of pts’ survival within 5 years from starting HD, by applying a multivariate competing risk model depending on the first VA used to start HD (AVF versus catheter), was: 1.88 (95% CI: 1.76–2.01, P &lt; 0.001) for non-DM pts, 1.58 (95% CI: 1.17–2.15, P = 0.003) for DM-1 pts and 1.54 (95% CI: 1.41–1.68, P &lt; 0.001) for DM-2 pts. Compared with non-DM pts starting HD by AVF (reference), the HR of death within 5 years from starting HD through an AVF was 1.02 (95% CI: 0.83–1.24, P = 0.81) for DM-1 pts and 1.32 (95% CI: 1.23–1.41, P &lt; 0.001) for DM-2 pts. Compared with non-DM pts starting HD with catheter (reference), the HR of death within 5 years from starting HD through a catheter was 1.22 (95% CI: 0.95–1.56, P = 0.12) for DM-1 pts and 1.70 (95% CI: 1.55–1.85, P &lt; 0.001) for DM-2 pts.

CONCLUSIONS

i) The VA profile of incident DM-2 pts was different compared with DM-1 and non-DM pts due to the different types of catheter used for starting HD. ii) DM-2 pts showed an 11% lower probability of initiating HD through an AVF compared with non-DM pts. iii) Incident DM-1 pts with AVF and DM-2 pts with catheter showed the maximum and minimum probability to receive a KG within 5 years from starting HD, respectively. iv) Incident DM-2 pts with catheter and non-DM pts with AVF showed the maximum and minimum risk of dying within 5 years from starting HD, respectively.