Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis. Manns Braden,Tonelli Marcello,Yilmaz Serdar,Lee Helen,Laupland Kevin,Klarenbach Scott,Radkevich Val,Murphy Brendan Journal of the American Society of Nephrology : JASN Despite the importance of hemodialysis vascular access, the cost of vascular access care has not been studied in detail. A prospective cost analysis was performed among incident hemodialysis patients to determine the cost of vascular access care overall and on the basis of access type. Detailed clinical and demographic information, as well as data on access type, was collected for all local incident hemodialysis patients between July 1, 1999, and November 1, 2001. A comprehensive measure of total vascular access costs, including surgery, radiology, hospitalization for access complications, physician costs, costs for management of outpatient bacteremia, and vascular access monitoring costs, was obtained. Costs are reported in 2002 Canadian dollars (1 CAN dollar = 0.69 US dollar). A total of 239 consecutive incident hemodialysis patients were identified, 49, 157, and 33 of whom were dialyzed exclusively with a catheter or had a native arteriovenous fistula or synthetic graft attempted, respectively. In year 1, 18.4% of all hospital admissions were for vascular access-related complications. The mean cost of all vascular access care in year 1 was 6890 CAN dollars(median 4020 dollars; interquartile range [IQR] 2440 dollars to 7540 dollars). The mean cost of access care per patient-year at risk for maintaining a catheter exclusively, attempting an arteriovenous fistula, or attempting a graft was 9180 dollars (median 3812 dollars; IQR 2250 dollars to 7762 dollars), 7989 dollars (median 4641 dollars ; IQR 3035 dollars to 8832 dollars), and 11,685 dollars (median 8152 dollars; IQR 3395 dollars to 12,908 dollars), respectively (P = 0.01). Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results support clinical practice guidelines that recommend preferential placement of a native fistula. 10.1681/ASN.2004050355

Economic burden of maintenance hemodialysis patients' families in Nanchong and its influencing factors. Ma Yunyan,Yu Hang,Sun Hongbing,Li Mi,Li Li,Qin Meng Annals of palliative medicine BACKGROUND:Maintenance hemodialysis is the main therapy for clinical treatment of end-stage renal disease (ESRD). The aim of this study was to analyze the current status of the economic burden levied on families with members who are maintenance hemodialysis patients in Nanchong, and the related influencing factors. METHODS:A total of 111 patients with ESRD who were admitted to our hospital from April 2018 to April 2020 and treated with maintenance hemodialysis were selected as research subjects. A questionnaire survey was adopted as a data collection and interview method to observe the economic burden of families with a member who was a maintenance hemodialysis patient. Logistic regression analysis was used to analyze the independent risk factors that affect this economic burden. RESULTS:The direct economic burden, indirect economic burden, and average annual total economic burden (the sum of the direct economic burden and indirect economic burden of hemodialysis patients) of patients in the resident medical insurance group were significantly higher than those in the employee medical insurance group, resident medical insurance + poverty relief group, and employee medical insurance + poverty relief group (P<0.05). The analysis of the unconditional multifactor logistic regression model showed that age, occupation, monthly family income, and medical insurance type were independent risk factors that affected the average annual total economic burden of patients with maintenance hemodialysis (P<0.01). CONCLUSIONS:Various medical insurance systems can effectively reduce the economic burden of hemodialysis patients, but patients must still bear significant financial hardship. It is necessary to further improve the medical insurance for patients with hemodialysis and increase management efforts to popularize the poverty relief policy. 10.21037/apm-20-1787