Table 4.

Procedure rates and incidence rate ratios in the first year of hemodialysis

OutcomesPre–Vascular Access Team (2004–2005), n=146Early Vascular Access Team (2006–2008), n=252Late Vascular Access Team (2009–2011), n=211
All participants (n=609)
 All procedures4 (2.9 to 5.5)4.7 (3.4 to 6.4)4.3 (3.1 to 5.9)
  Incidence rate ratios1 (Reference)1.2 (1.1 to 1.4)a1.1 (0.9 to 1.3)
 Catheter-related procedures3.8 (2.1 to 6.7)3.8 (2.2 to 6.6)3.5 (2 to 5.9)
  Incidence rate ratios1 (Reference)1 (0.8 to 1.3)0.9 (0.7 to 1.2)
 Fistula-related procedures (including creation attempts)1.1 (0.8 to 1.6)1.5 (1 to 2.2)1.4 (1 to 2)
  Incidence rate ratios1 (Reference)1.4 (1.2 to 1.6)a1.3 (1.1 to 1.5)a
 Fistula-related procedures (without creation attempts)0.5 (0.3 to 0.8)0.8 (0.5 to 1.3)0.7 (0.4 to 1.2)
  Incidence rate ratios1 (Reference)1.6 (1.2 to 2)a1.5 (1.1 to 1.9)a
Participants who received a fistula attempt (n=437)n=102n=196n=139
 All procedures4.2 (3 to 5.9)4.5 (3.3 to 6.3)4.6 (3.3 to 6.4)
  Incidence rate ratios1 (Reference)1.1 (0.9 to 1.2)1.1 (0.9 to 1.3)
 Catheter-related procedures2.7 (1.3 to 5.3)2.2 (1.2 to 4.3)2.3 (1.2 to 4.3)
  Incidence rate ratios1 (Reference)0.8 (0.6 to 1.1)0.9 (0.6 to 1.2)
 Fistula-related procedures (including creation attempts)1.9 (1.4 to 2.7)2.4 (1.7 to 3.3)2.4 (1.7 to 3.3)
  Incidence rate ratios1 (Reference)1.3 (1.1 to 1.5)a1.3 (1.1 to 1.5)a
 Fistula-related procedures (without creation attempts)0.8 (0.5 to 1.4)1.2 (0.7 to 1.9)1.2 (0.7 to 1.9)
  Incidence rate ratios1 (Reference)1.5 (1.1 to 1.8)a1.4 (1.1 to 1.9)a
 Procedures to promote maturation0.2 (0.0 to 0.7)0.2 (0.0 to 0.8)0.2 (0.1 to 1.1)
  Incidence rate ratios1 (Reference)1.3 (0.6 to 2.8)1.7 (0.8 to 3.7)
Participants who did not receive a fistula attempt (n=172)n=44n=56n=72
 Catheter-related procedures5.1 (2 to 13)8.5 (3.2 to 22)5.5 (2.2 to 13)
  Incidence rate ratios1 (Reference)1.7 (0.9 to 2.8)1.1 (0.6 to 1.8)
  • Reported rates represent the number of procedures per person-years (mean and 95% confidence intervals). All negative binomial models are adjusted for age, sex, diabetes, and cardiovascular disease status. The incidence rate ratios provide an estimate of the change in procedure rate relative to the preteam period. Full models are reported in the Supplemental Material (Supplemental Tables 4–13).

  • a Fistula-related procedure rates were significantly increased after access team implementation.