Clinical EpidemiologyArteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs FacilitiesHurst, Frank P.*,†; Abbott, Kevin C.*,†; Raj, Dominic‡; Krishnan, Mahesh§; Palant, Carlos E.‡,‖; Agodoa, Lawrence Y.¶; Jindal, Rahul M.‡,**,†† Author Information *Nephrology Service and **Organ Transplant Service, Walter Reed Army Medical Center, Washington, DC; †Uniformed Services University of Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland; ‡Division of Renal Diseases and Hypertension, George Washington University, Washington, DC; §Davita Clinical Research, Washington, DC; ‖Nephrology Service, Veterans Affairs Medical Center, Washington, DC; ¶National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and ††Department of Surgery, Brookdale University Medical Center, Brooklyn, New York Correspondence: Dr. Frank P. Hurst, Department of Medicine/Nephrology, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307. Phone: 202-782-6462; Fax: 202-782-0185; E-mail: [email protected] Received January 6, 2010 Accepted April 1, 2010 Journal of the American Society of Nephrology 21(9):p 1571-1577, September 2010. | DOI: 10.1681/ASN.2010010025 Buy Metrics Abstract A higher proportion of patients initiate hemodialysis (HD) with an arteriovenous fistula (AVF) in countries with universal health care systems compared with the United States. Because federally sponsored national health care organizations in the United States, such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD), are similar to a universal health care model, we studied AVF use within these organizations. We used the US Renal Data System database to perform a cross-sectional analysis of patients who initiated HD between 2005 and 2006. Patients who received predialysis nephrology care had 10-fold greater odds of initiating dialysis with an AVF (adjusted odds ratio [aOR] 10.3; 95% confidence interval [CI] 9.6 to 11.1). DVA/DoD insurance also independently associated with initiating HD with an AVF (aOR 1.4; 95% CI 1.2 to 1.5). Fewer patients initiated HD at a DoD facility, but these patients were also approximately twice as likely to use an AVF (aOR 2.3; 95% CI 1.2 to 4.6). In conclusion, patients in DVA/DoD systems are significantly more likely to use an AVF at initiation of HD than patients with other insurance types, including Medicare. Further study of these federal systems may identify practices that could improve processes of care across health care systems to increase the number of patients who initiate HD with an AVF. Copyright © 2010 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.