Racial Disparities in the Arteriovenous Fistula Care Continuum in Hemodialysis Patients.
Black or African American
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical
/ adverse effects
Databases, Factual
Female
Healthcare Disparities
Humans
Kidney Diseases
/ diagnosis
Longitudinal Studies
Male
Medicare
Race Factors
Renal Dialysis
/ adverse effects
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
White People
arteriovenous access
arteriovenous fistula
dialysis access
disparity
hemodialysis access
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 12 2020
07 12 2020
Historique:
received:
19
03
2020
accepted:
17
09
2020
pubmed:
22
10
2020
medline:
15
12
2021
entrez:
21
10
2020
Statut:
ppublish
Résumé
Arteriovenous fistulas are the optimal vascular access type for patients on hemodialysis. However, arteriovenous fistulas are used less frequently in Black than in White individuals. The arteriovenous fistula care continuum comprises a series of sequential steps. A better understanding is needed of where disparities exist along the continuum in order to mitigate racial differences in arteriovenous fistula use. Using Medicare claims data from the United States Renal Data System, longitudinal analyses of patients ≥67 years initiating hemodialysis with a central venous catheter between July 1, 2010 and June 30, 2012 were performed. Three patient cohorts were identified: patients initiating hemodialysis with a catheter ( An arteriovenous fistula was placed within 6 months of dialysis initiation in 37% of patients initiating dialysis with a catheter. Among the patients with arteriovenous fistula placement, the arteriovenous fistula was successfully used for dialysis within 6 months in 48% of patients. Among patients with successful arteriovenous fistula use, 21% maintained primary arteriovenous fistula patency at 3 years. After adjusting for competing risks, Black patients on hemodialysis were 10% less likely to undergo arteriovenous fistula placement (adjusted subdistribution hazard ratio, 0.90; 95% confidence interval, 0.87 to 0.94); 12% less likely to have successful arteriovenous fistula use after placement (adjusted subdistribution hazard ratio, 0.88; 95% confidence interval, 0.83 to 0.93); and 22% less likely to maintain primary arteriovenous fistula patency after successful use (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.74 to 0.84). Lower arteriovenous fistula use among Blacks older than 67 years of age treated with hemodialysis was attributable to each step along the continuum of arteriovenous fistula processes of care.
Sections du résumé
BACKGROUND AND OBJECTIVES
Arteriovenous fistulas are the optimal vascular access type for patients on hemodialysis. However, arteriovenous fistulas are used less frequently in Black than in White individuals. The arteriovenous fistula care continuum comprises a series of sequential steps. A better understanding is needed of where disparities exist along the continuum in order to mitigate racial differences in arteriovenous fistula use.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Using Medicare claims data from the United States Renal Data System, longitudinal analyses of patients ≥67 years initiating hemodialysis with a central venous catheter between July 1, 2010 and June 30, 2012 were performed. Three patient cohorts were identified: patients initiating hemodialysis with a catheter (
RESULTS
An arteriovenous fistula was placed within 6 months of dialysis initiation in 37% of patients initiating dialysis with a catheter. Among the patients with arteriovenous fistula placement, the arteriovenous fistula was successfully used for dialysis within 6 months in 48% of patients. Among patients with successful arteriovenous fistula use, 21% maintained primary arteriovenous fistula patency at 3 years. After adjusting for competing risks, Black patients on hemodialysis were 10% less likely to undergo arteriovenous fistula placement (adjusted subdistribution hazard ratio, 0.90; 95% confidence interval, 0.87 to 0.94); 12% less likely to have successful arteriovenous fistula use after placement (adjusted subdistribution hazard ratio, 0.88; 95% confidence interval, 0.83 to 0.93); and 22% less likely to maintain primary arteriovenous fistula patency after successful use (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.74 to 0.84).
CONCLUSIONS
Lower arteriovenous fistula use among Blacks older than 67 years of age treated with hemodialysis was attributable to each step along the continuum of arteriovenous fistula processes of care.
Identifiants
pubmed: 33082199
pii: 01277230-202012000-00015
doi: 10.2215/CJN.03600320
pmc: PMC7769016
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1796-1803Subventions
Organisme : NIMHD NIH HHS
ID : R01 MD013818
Pays : United States
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, Bhave N, Dietrich X, Ding Z, Eggers PW, Gaipov A, Gillen D, Gipson D, Gu H, Guro P, Haggerty D, Han Y, He K, Herman W, Heung M, Hirth RA, Hsiung JT, Hutton D, Inoue A, Jacobsen SJ, Jin Y, Kalantar-Zadeh K, Kapke A, Kleine CE, Kovesdy CP, Krueter W, Kurtz V, Li Y, Liu S, Marroquin MV, McCullough K, Molnar MZ, Modi Z, Montez-Rath M, Moradi H, Morgenstern H, Mukhopadhyay P, Nallamothu B, Nguyen DV, Norris KC, O’Hare AM, Obi Y, Park C, Pearson J, Pisoni R, Potukuchi PK, Repeck K, Rhee CM, Schaubel DE, Schrager J, Selewski DT, Shamraj R, Shaw SF, Shi JM, Shieu M, Sim JJ, Soohoo M, Steffick D, Streja E, Sumida K, Kurella Tamura M, Tilea A, Turf M, Wang D, Weng W, Woodside KJ, Wyncott A, Xiang J, Xin X, Yin M, You AS, Zhang X, Zhou H, Shahinian V: US Renal Data System 2018 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 73[Suppl 1]: A7–A8, 2019 30798791
Vascular Access 2006 Work Group: Clinical practice guidelines for vascular access. Am J Kidney Dis 48[Suppl 1]: S176–S247, 2006 16813989
Allon M, Robbin ML: Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions. Kidney Int 62: 1109–1124, 2002 12234281
ESRD National Coordinating Center: Fistula First Catheter Last. Available at: http://esrdncc.org/ffcl/ . Accessed October 28, 2019
Arya S, Melanson TA, George EL, Rothenberg KA, Kurella Tamura M, Patzer RE, Hockenberry JM: Racial and sex disparities in catheter use and dialysis access in the United States Medicare population. J Am Soc Nephrol 31: 625–636, 2020 31941721
Allon M: Current management of vascular access. Clin J Am Soc Nephrol 2: 786–800, 2007 17699495
Solid CA, Carlin C: Timing of arteriovenous fistula placement and Medicare costs during dialysis initiation. Am J Nephrol 35: 498–508, 2012 22584153
Hod T, Patibandla BK, Vin Y, Brown RS, Goldfarb-Rumyantzev AS: Arteriovenous fistula placement in the elderly: When is the optimal time? J Am Soc Nephrol 26: 448–456, 2015 25168024
Lee T, Qian J, Thamer M, Allon M: Tradeoffs in vascular access selection in elderly patients initiating hemodialysis with a catheter. Am J Kidney Dis 72: 509–518, 2018 29784614
Lee T, Qian JZ, Zhang Y, Thamer M, Allon M: Long-term outcomes of arteriovenous fistulas with unassisted versus assisted maturation: A retrospective national hemodialysis cohort study. J Am Soc Nephrol 30: 2209–2218, 2019 31611240
Solid CA, Collins AJ, Ebben JP, Chen SC, Faravardeh A, Foley RN, Ishani A: Agreement of reported vascular access on the medical evidence report and on Medicare claims at hemodialysis initiation. BMC Nephrol 15: 30, 2014 24507475
Lee T, Thamer M, Zhang Q, Zhang Y, Allon M: Vascular access type and clinical outcomes among elderly patients on hemodialysis. Clin J Am Soc Nephrol 12: 1823–1830, 2017 28798220
Lee T, Thamer M, Zhang Q, Zhang Y, Allon M: Reduced cardiovascular mortality associated with early vascular access placement in elderly patients with chronic kidney disease. Am J Nephrol 43: 334–340, 2016 27166150
Liu J, Huang Z, Gilbertson DT, Foley RN, Collins AJ: An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int 77: 141–151, 2010 19907414
Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP: Social determinants of racial disparities in CKD. J Am Soc Nephrol 27: 2576–2595, 2016 27178804
Powe NR: Let’s get serious about racial and ethnic disparities. J Am Soc Nephrol 19: 1271–1275, 2008 18524999
Saran R, Li Y, Robinson B, Abbott KC, Agodoa LY, Ayanian J, Bragg-Gresham J, Balkrishnan R, Chen JL, Cope E, Eggers PW, Gillen D, Gipson D, Hailpern SM, Hall YN, He K, Herman W, Heung M, Hirth RA, Hutton D, Jacobsen SJ, Kalantar-Zadeh K, Kovesdy CP, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, Nguyen DV, O’Hare AM, Plattner B, Pisoni R, Port FK, Rao P, Rhee CM, Sakhuja A, Schaubel DE, Selewski DT, Shahinian V, Sim JJ, Song P, Streja E, Kurella Tamura M, Tentori F, White S, Woodside K, Hirth RA: US Renal Data System 2015 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 67: S1–S305, 2016
Haider AH, Schneider EB, Sriram N, Dossick DS, Scott VK, Swoboda SM, Losonczy L, Haut ER, Efron DT, Pronovost PJ, Freischlag JA, Lipsett PA, Cornwell EE 3rd, MacKenzie EJ, Cooper LA: Unconscious race and class bias: Its association with decision making by trauma and acute care surgeons. J Trauma Acute Care Surg 77: 409–416, 2014 25159243
Ishaque B, Zayed MA, Miller J, Nguyen D, Kaji AH, Lee JT, O’Connell J, de Virgilio C: Ethnic differences in arm vein diameter and arteriovenous fistula creation rates in men undergoing hemodialysis access. J Vasc Surg 56: 424–431, 2012 22551911
Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D: Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 17: 3204–3212, 2006 16988062
Singh P, Robbin ML, Lockhart ME, Allon M: Clinically immature arteriovenous hemodialysis fistulas: Effect of US on salvage. Radiology 246: 299–305, 2008 17991787
Crews DC, Novick TK: Achieving equity in dialysis care and outcomes: The role of policies. Semin Dial 33: 43–51, 2020 31899828
Hemphill H, Allon M, Konner K, Work J, Vassalotti JA: How can the use of arteriovenous fistulas be increased? Semin Dial 16: 214–223, 2003 12753680
Sullivan C, Leon JB, Sayre SS, Marbury M, Ivers M, Pencak JA, Bodziak KA, Hricik DE, Morrison EJ, Albert JM, Navaneethan SD, Reyes CM, Sehgal AR: Impact of navigators on completion of steps in the kidney transplant process: A randomized, controlled trial. Clin J Am Soc Nephrol 7: 1639–1645, 2012 22798540
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP; National Kidney Foundation: KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 75[Suppl 2]: S1–S164, 2020 32778223