1. 2015 ANNUAL DATA REPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE Chapter 4: Vascular Access

2. Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating hemodialysis in 2005-2013. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease. Figure 4.1 Vascular access use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2005-2013 Vol 2, ESRD, Ch 42

3. 3 AV fistula AV graft Catheter with maturing fistula Catheter with maturing graft Catheter only All17.12.818.02.060.2 Age 0-217.60.69.91.080.9 22-4413.21.918.31.665.0 45-6417.12.6191.759.5 65-7418.63.018.42.157.9 75+17.33.516.12.360.8 Sex Male18.72.118.41.659.2 Female14.93.817.42.461.4 Race White17.92.317.61.760.5 Black/African American15.54.218.52.759.0 Native American14.92.8251.455.9 Asian20.02.919.31.856.0 Ethnicity Hispanic12.41.216.71.468.3 Primary Cause of ESRD Diabetes17.72.920.92.056.4 Hypertension17.53.216.62.060.6 Glomerulonephritis18.62.316.51.860.7 Cystic Kidney43.64.015.21.535.8 Other Urologic14.23.314.42.166.0 Other Cause9.21.811.51.775.9 Unknown/Missing11.12.413.92.070.5 Comorbidities Diabetes16.82.919.82.058.5 Congestive heart failure13.32.419.32.262.8 Atherosclerotic heart disease172.620.62.157.7 Cerebrovascular disease153.418.92.560.2 Peripheral vascular disease14.82.520.82.159.7 Hypertension17.82.918.42.058.9 Other cardiac disease14.52.417.92.163.1 Vol 2, ESRD, Ch 4 Table 4.1 Vascular access used at hemodialysis initiation by patient characteristics from the ESRD Medical Evidence form (CMS 2728), 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

4. 4Vol 2, ESRD, Ch 4 Figure 4.2 Geographic variation in percentage of catheter-only use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: CMS, Centers for Medicare & Medicaid; ESRD, end- stage renal disease.

5. 5Vol 2, ESRD, Ch 4 Figure 4.3 Geographic variation in percentage of AV fistula use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

6. 6 AV fistula AV graftCatheter All62.518.419.2 Age 0-2147.06.846.1 22-4464.815.719.6 45-6464.217.718.1 65-7461.919.318.8 75+58.720.420.9 Sex Male68.714.217.1 Female54.523.721.8 Race White64.313.622.1 Black/African American56.925.417.7 Native American73.312.114.6 Asian67.216.716.1 Ethnicity Hispanic67.515.417.1 Primary Cause of ESRD Diabetes62.718.219.1 Hypertension61.919.318.8 Glomerulonephritis64.818.117.2 Cystic Kidney69.516.913.7 Other Urologic61.917.620.4 Other Cause57.517.225.3 Unknown/Missing61.417.621.0 Vol 2, ESRD, Ch 4 Table 4.2 Distribution of type of vascular access in use among prevalent hemodialysis patients in 2013, from CROWNWeb data, December 2013 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb data catheter=any catheter use; fistula and graft use shown are without the use of a catheter. Abbreviations: AV, arteriovenous; ESRD, end-stage renal disease.

7. 7Vol 2, ESRD, Ch 4 Figure 4.4 Geographic variation in percentage catheter use among prevalent hemodialysis patients by Health Service Area, from CROWNWeb data, December 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviation: ESRD, end-stage renal disease.

8. 8Vol 2, ESRD, Ch 4 Figure 4.5 Geographic variation in percentage AV fistula use among prevalent hemodialysis patients by Health Service Area, from CROWNWeb data, December 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; ESRD, end-stage renal disease.

9. 9Vol 2, ESRD, Ch 4 Figure 4.6 Trends in vascular access type use among ESRD prevalent patients, 2003-2014 Data Source: Special analyses, USRDS ESRD Database, and Fistula First data. Fistula First data reported from July 2003 through April 2012, CROWNWeb data are reported from June 2012 through December 2013. Abbreviations: AV, arteriovenous; ESRD, end-stage renal disease.

10. 10Vol 2, ESRD, Ch 4 Figure 4.7 Vascular access use during the first year of hemodialysis by time since initiation of ESRD treatment, among patients new to hemodialysis in 2013, from the ESRD Medical Evidence form (CMS 2728) and CROWNWeb data, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. Abbreviations: CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

11. 11 Age groupAccess type Time At initiation 3 months6 months9 months1 year 0-21AV fistula7.513.431.946.050.6 AV graft0.6 2.32.93.1 Catheter91.886.065.851.246.3 22-44AV fistula13.322.444.659.567.2 AV graft1.94.47.69.410.8 Catheter84.873.247.931.122.0 45-64AV fistula17.225.346.160.267.1 AV graft2.65.59.111.613.1 Catheter80.269.244.828.319.8 65-74AV fistula18.727.146.759.165.6 AV graft3.06.911.013.515.0 Catheter78.366.142.327.419.5 75+AV fistula17.424.943.656.161.5 AV graft3.58.514.016.918.5 Catheter79.166.642.427.120.0 Vol 2, ESRD, Ch 4 Table 4.3 Cross-sectional distributions of vascular access use during the first year of hemodialysis therapy among patients new to hemodialysis in 2013, by age group, from the ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

12. 12 RaceAccess type Time At initiation3 months6 months9 months1 year Native AmericanAV fistula14.725.553.370.077.1 AV graft2.24.36.16.98.1 Catheter83.170.240.623.214.8 AsianAV fistula20.229.451.664.370.5 AV graft2.86.59.411.813.5 Catheter77.064.139.023.916.0 BlackAV fistula15.422.540.152.858.8 AV graft4.28.914.717.919.8 Catheter80.468.545.329.321.4 WhiteAV fistula17.726.247.261.067.8 AV graft2.35.48.911.012.2 Catheter80.068.443.928.020.0 Other/UnknownAV fistula16.512.339.557.362.5 AV graft4.16.22.64.05.6 Catheter79.381.557.938.731.9 Vol 2, ESRD, Ch 4 Table 4.4 Cross-sectional distributions of vascular access use during the first year of hemodialysis therapy among patients new to hemodialysis in 2013, by race, from the ESRD Medical Evidence form (CMS-2728) and CROWNWeb, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease..

13. 13 SexAccess type Time At initiation3 months6 months9 months1 year Male AV fistula18.828.651.065.171.5 AV graft2.14.98.09.911.0 Catheter79.166.541.025.017.5 Female AV fistula15.020.837.950.256.9 AV graft3.88.614.017.419.3 Catheter81.270.648.132.423.7 Vol 2, ESRD, Ch 4 Table 4.5 Cross-sectional distributions of vascular access use during the first year of hemodialysis therapy among patients new to hemodialysis in 2013, by sex, from the ESRD Medical Evidence form (CMS 2728) and CROWNWeb, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. Medical Evidence form (CMS 2728) at initiation and CROWNWeb for subsequent time periods. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease..

14. 14Vol 2, ESRD, Ch 4 Table 4.6 Odds ratios and 95% confidence intervals from logistic regression models of fistula use at hemodialysis initiation and fistula or graft use at hemodialysis initiation, from the ESRD Medical Evidence form (CMS 2728), 2013 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; CMS, Centers for Medicare & Medicaid; ESRD, end-stage renal disease.

15. 15 Total AV fistula placements Percentage of failed placements Number of days between AV fistula placement and first use AverageMedian 25 th percentile 75 th percentile Overall45,47535.913511274171 Age 0-2123031.713911071174 22-445,42932.313210670169 45-6417,18433.913411172169 65-7412,19136.613711576174 75+10,44140.613711578171 Race Native American48526.613511776165 Asian1,85727.812810667168 Black/African American14,58238.813611371175 White28,50135.213511276170 Other/Unknown5034.012211371146 Sex Male25,69331.812910873161 Female19,78241.314512077188 Primary Cause of ESRD Diabetes21,30336.213711576174 Hypertension13,68135.313311173169 Glomerulonephritis4,03733.413010468167 Cystic kidney73936.713511166173 Other urologic68734.612810971161 Other cause3,71438.413411172168 Unknown cause1,31439.115312078195 Vol 2, ESRD, Ch 4 Table 4.7 Distribution of number of days between AV fistula placement and first successful use*, overall and by patient characteristics, for new AV fistula created in 2013 (excludes patients not yet ESRD when fistula was placed), from Medicare claims and CROWNWeb, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. *With follow-up through the end of 2014; date of first use was the date the given access was first reported in CROWNWeb to be in use in a particular patient. Abbreviations: AV, arteriovenous; ESRD, end-stage renal disease.

16. 16Vol 2, ESRD, Ch 4 Figure 4.8 Percentage of failed fistula placements, by Health Service Area, for new AV fistulas created in 2013 (excludes patients not yet ESRD when fistula was placed), from Medicare claims and CROWNWeb, 2013-2014 Data Source: Special analyses, USRDS ESRD Database. Abbreviations: AV, arteriovenous; ESRD, end-stage renal disease.