Veterans More Likely to Start Hemodialysis with an Arteriovenous Fistula

摘要: Hemodialysis via arteriovenous fistulas (AVFs) is associated with reduced morbidity and mortality when compared to alternative vascular accesses, yet few patients in the United States start dialysis AVFs. Recent studies have demonstrated higher quality of care for many conditions Veterans Affairs’ Medical Centers (VAMC); however, differences access are unknown. We used patient-level data (6/05–5/06) from Medicare claims (n = 25,912) compare proportions AVF among incident at VAMC-affiliated (n = 20) unaffiliated (n = 1631) facilities. Multivariate logistic regression was determine whether associations type facility were independent. Compared non-VAMC patients, a larger proportion VAMC started AVFs (20.9% versus 11.6% patients; OR 1.99, [95% CI 1.55–2.56]). Although attenuated, this finding persisted models adjusted demographics (OR 1.65 1.28–2.13]) comorbidities 1.70 1.31–2.20]). However, after accounting pre end-stage renal disease (ESRD) care, similar hemodialysis an 1.28 0.98–1.66]). In conclusion, receiving VAMC-associated facilities more likely AVFs, perhaps because better pre-ESRD care. Nonetheless, rates remain suboptimal, indicating need ongoing evaluation improvement.