Table 1.
Baseline characteristics of patients who initiated hemodialysis for ESKD
| Variable | All Patients | No Arteriovenous Access Creation | One or More Arteriovenous Access Creations | Standardized Difference (%)a |
|---|---|---|---|---|
| Total number, N | 17,183 | 12,627 | 4556 | |
| Age (yr) at hemodialysis start, N (%) | ||||
| Mean (SD) | 65.8 (15.1) | 65.7 (15.5) | 65.9 (13.9) | 1 |
| <65 | 6928 (40) | 5094 (40) | 1834 (40) | <1 |
| 65–74 | 4476 (26) | 3179 (25) | 1297 (29) | 7 |
| 75–84 | 4711 (27) | 3487 (28 | 1224 (27) | 2 |
| >84 | 1068 (6) | 867 (7) | 201 (4) | 11 |
| Men, N (%) | 10,269 (60) | 7339 (58) | 2930 (64) | 13 |
| Race, N (%) | ||||
| Asian | 914 (5) | 554 (5) | 249 (5) | 1 |
| Black | 774 (5) | 569 (5) | 205 (5) | <1 |
| Other | 1866 (11) | 1389 (11) | 477 (10) | 1 |
| Unknown | 740 (4) | 524 (4) | 216 (5) | 2 |
| White | 12,889 (75) | 9480 (75) | 3409 (75) | 3 |
| Acute dialysis start,b N (%) | 7655 (45) | 6576 (52) | 1079 (24) | 60 |
| Evidence of AKI within 6 mo of hemodialysis start, N (%) | 4809 (28) | 4337 (34) | 472 (10) | 60 |
| Primary etiology of ESKD diagnosis, N (%) | ||||
| GN | 1636 (9) | 1151 (9) | 485 (11) | 5 |
| Diabetes | 6187 (36) | 4291 (34) | 1896 (42) | 16 |
| Renal vascular disease | 3610 (21) | 2652 (21) | 958 (21) | <1 |
| Polycystic kidney disease | 544 (3) | 213 (2) | 331 (7) | 27 |
| Other | 2893 (17) | 2447 (19) | 446 (10) | 27 |
| Unknown | 2313 (14) | 1873 (15) | 440 (10) | 16 |
| Comorbidities, N (%) | ||||
| Diabetes mellitus | 8030 (47) | 5763 (46) | 2267 (50) | 8 |
| CHF | 8118 (47) | 6249 (49) | 1869 (41) | 17 |
| Coronary artery disease | 10,334 (60) | 7547 (60) | 2787 (61) | 3 |
| Coronary artery bypass graft/percutaneous coronary intervention | 2699 (16) | 2042 (16) | 657 (14) | 5 |
| Peripheral vascular disease | 3816 (22) | 2602 (21) | 1214 (27) | 14 |
| Cerebrovascular disease | 2865 (17) | 2189 (17) | 676 (15) | 7 |
| Leukemia | 1291 (8) | 1078 (9) | 213 (5) | 16 |
| Lymphoma | 118 (1) | 103 (1) | 15 (0) | 6 |
| Other cancerc | 7470 (43) | 6423 (51) | 1047 (23) | 60 |
| Lung disease (chronic obstructive pulmonary disease) | 3098 (18) | 2401 (19) | 697 (15) | 9 |
| Dementia | 1284 (7) | 1015 (8) | 269 (6) | 8 |
| Hypertension | 15,571 (91) | 11,276 (89) | 4295 (94) | 18 |
| Other serious illnessd | 1850 (11) | 1540 (12) | 310 (7) | 18 |
| Smoking | 2079 (12) | 1630 (13) | 449 (10) | 9 |
| ESKD comorbidity index,e N (%) | ||||
| 0 | 2001 (12) | 1424 (11) | 577 (13) | 4 |
| 1 | 513 (3) | 348 (3) | 165 (4) | 5 |
| 2 | 1677 (10) | 1189 (9) | 488 (11) | 4 |
| 3 | 1538 (9) | 1108 (9) | 430 (9) | 2 |
| 4 | 1725 (10) | 1294 (10) | 431 (9) | 3 |
| 5 | 2091 (12) | 1491 (12) | 600 (13) | 4 |
| 6 | 1509 (9) | 1101 (9) | 408 (9) | 1 |
| 7+ | 6129 (36) | 4672 (37) | 1457 (32) | 11 |
| Year of hemodialysis start, N (%) | ||||
| 2001–2003 | 4724 (27) | 3207 (25) | 1517 (33) | 17 |
| 2004–2006 | 5164 (31) | 3749 (30) | 1415 (31) | 3 |
| 2007–2010 | 7295 (42) | 5671 (45) | 1624 (36) | 9 |
| Location of dialysis treatments, N (%) | ||||
| Acute care hospital | 16,859 (98) | 12,479 (99) | 4380 (96) | 17 |
| Community center | 261 (2) | 129 (1) | 132 (3) | 14 |
| Home hemodialysis | 63 (<1) | 19 (<1) | 44 (1) | 11 |
| Assistance/care with dialysis treatments, N (%) | ||||
| Total care | 17,094 (99) | 12,592 (100) | 4502 (99) | 11 |
| Limited self-care | 25 (<1) | 15 (<1) | 10 (<1) | 3 |
| Total self-care | 64 (<1) | 20 (<1) | 44 (1) | 11 |
| Laboratory valuef | ||||
| Albumin mean (SD), g/dl | 3.2 (0.7) | 3.1 (0.7) | 3.4 (0.6) | 46 |
| Hemoglobin mean (SD), g/dl | 10.0 (1.74) | 9.8 (1.73) | 10.6 (1.63) | 48 |
| eGFRg (ml/min per 1.73 m2) median (quartile 1, quartile 3) | 9 (6, 12) | 9 (6, 12) | 9 (7, 12) | 6 |
| Late referral,h N (%) | 6892 (40) | 6343 (50) | 549 (12) | 89 |
| Early initiation,i N (%) | 6015 (35) | 4464 (35) | 1551 (34) | 3 |
| Rural residence, N (%) | 2197 (13) | 1170 (14) | 427 (9) | 15 |
CHF, congestive heart failure.
Standardized differences describe differences between group means or proportions relative to the pooled SD. A standardized difference >10% is accepted as a meaningful difference (18).
Having a dialysis treatment as an inpatient in the 2 weeks before hemodialysis start.
Other cancer included all other types of cancer (excluding skin cancer but including melanoma).
Other serious illness that may shorten life expectancy <5 years.
The ESKD comorbidity index is a modified Charlson–weighted score on the basis of the history of the following comorbidities: congestive heart failure (CHF), peripheral vascular disease, cerebral vascular disease, dementia, chronic lung disease, rheumatologic comorbidities, peptic ulcer disease, diabetes, diabetes with complications, moderate/severe liver disease, metastatic disease, leukemia, and lymphoma (20).
Last laboratory values before starting hemodialysis.
eGFR calculated using the creatinine level at the last laboratory evaluation before hemodialysis start and the Modification of Diet in Renal Disease formula.
Late referral defined as first seen by a nephrologist <90 days before initiation of dialysis.
Early initiation defined as eGFR>10.5 ml/min per 1.73 m2 at the start of dialysis.