SIR 2024
Renal and GU Interventions
Ibukunoluwa Ibrahim, BS (he/him/his)
Medical Student
University of California, San Francisco
Financial relationships: Full list of relationships is listed on the CME information page.
Xiao Wu, MD (she/her/hers)
Resident Physician
University of California, San Francisco
Financial relationships: Full list of relationships is listed on the CME information page.
Vishal Kumar, Associate Professor
Associate Program Director
UCSF / ZSFG
Disclosure information not submitted.
Miles B. Conrad, MD , DR IR Board certified ABR (he/him/his)
Professor
UCSF
Financial relationships: Full list of relationships is listed on the CME information page.
Sujal Nanavati, M.D.
Professor
University of California, San Francisco
Disclosure information not submitted.
A retrospective chart review of 280 consecutive patients, who underwent 845 procedures, either open fistulagram or fistula declotting, was conducted between July 2019 to March 2023. Super-utilizers were defined as those patients who underwent a minimum of 2 procedures within < 90 days, with a median procedural interval < 100 days. After excluding patients with only 1 procedure, the final analysis included 181 patients. Comparative analysis between super-utilizers and remaining patients employed independent t-tests for continuous variables and chi-squared tests for categorical variables. Multivariate analysis was performed with multiple logistic regression to identify independent predictors of high utilization. Socioeconomic factors were extracted and compared through subgroup analysis between the two groups. P value of < 0.05 was considered statistically significant.
Results:
The mean age was 62.1 (SD = 12.4) with a female to male ratio of 64:117. Subgroup analysis showed no difference in age and gender distribution between super-utilizers and remaining patients. There were 46 patients with AV grafts and 135 with AV fistulas. The number of procedures ranged from 2 to 16, with a median of 3 (interquartile range: 2-5). The median interval between procedures were 167 days and median procedure time was 91 minutes, with 32 super-utilizers identified. There was no difference in housing status, preferred language, or insurance type. There was no difference in terms of procedural time or nature (declots vs fistulagram), but super-utilizers were more likely to have exams ordered as STAT. Super-utilizers had a significantly higher BMI (29.1 vs 25.7) and more of them had AV grafts (46.9% vs 20.8%). White/Caucasian patients were more prevalent among super-utilizers (25.9% vs 6.7%), potentially implying discrepancy in access to care. Multivariate analysis showed identified White/Caucasian race (OR = 1.33, p = 0.013), Hispanic/Latino race (OR = 1.19, p = 0.047), BMI (OR = 1.01, p = 0.00143), and AV graft (OR = 1.28, p = 0.00361) being independent predictors of super-utilizer.
Conclusion: Patients with AV grafts, higher BMIs, and identifying as White/Caucasian were more likely to be super-utilizers. Understanding of these factors can aid in tailoring interventions to optimize utilization and enhance hemodialysis access point management.