Recently, we have analysed vascular access as a facility practice, and have found that a patient’s mortality risk is 21% higher for every 20% greater CATHETER use in the dialysis facility compared with AV fistula use.

Furthermore, a patient’s mortality risk was found to be 11% higher for every 20% greater GRAFT use in the dialysis facility.

These analyses were adjusted for patient demographics, baseline comorbidity, single pool Kt/V, and serum calcium and phosphorus levels.

DOPPS 2: Also saw 19% higher RR of septicemia per 10% greater facility catheter use (p<0.0001)

Values for Spain:

Septicemia Rate (per 100 patient years) = 3.17 (DOPPS 2) vs. 4.03 (DOPPS 3) which is a 27% increase

Country Catheter Use = 11.1% (DOPPS 2) vs. 20.6% (DOPPPS 3)

DOPPS 2 notes:

In DOPPS 2, we have seen that Japan displays the LOWEST rate of septicemia among all the countries in DOPPS.

In fact, the septicemia rate in Japan is 20-50 fold LOWER than that in the US, Canada, Sweden, and Belgium, and these countries have some of the highest catheter use in all of DOPPS.

A recent US study has found it to cost $24,024 (~2,400,000 yen) to treat a patient with septicemia when requiring hospitalization.

Certainly, there are other factors which impact rates of septicemia.  However, these DOPPS results strongly suggest that the excellent vascular access practice of low catheter use in Japan may be a very important factor resulting in low rates of septicemia, which not only is associated with better outcomes for patients but also provides a large cost savings to the National Health System.

• These are the individual diabetes management practices adjusted risks for all-cause mortality as having any routine vs no routine

• As you see patients from facilities that report as having a routine for all of these practices has significantly lower risk for mortality compared to patients from facility’s with no routine

• Compared to facility’s with primary diabetes physician as primary care physician, facility’s with nephrologist or endocrinologist have significantly lower mortality risk with hazard ratio of 0.69 and p-value 0.03.

• The practices that were not significant are hemoglobin A1c and also cardiovascular disease screening that was not shown here 

Figure 1: Case-mix adjusted mortality hazard ratio (HR) for HD patients in the US versus

Europe (EUR), with and without adjustment for differences in facility vascular access use.

The HR of mortality for HD patients in the US versus EUR (n=24,398) stratified by study phase

is shown after different levels of adjustment: unadjusted; adjusted for patient age, sex, black

race, number of years with ESRD, body weight, 14 summary comorbid conditions, whether

treated in a hospital-based unit, and facility median treatment time, facility % patients with

serum phosphorus >5.5 mg/dl, and facility % patients with serum calcium >10 mg/dl.; and,

further adjusted for % facility vascular access use plus the previous 23 adjustments. All models

accounted for facility clustering effects. EUR refers to France, Germany, Italy, Spain, and the

UK. Data source: Pisoni et al.6

Notes: Init_frn = 0, vintage > 90 days not on catheter

Excluding Japan, overall HR=1.21 (1.05-1.40)