title: Influence of vascular access type on sex and ethnicity-related mortality in hemodialysis-dependent patients.
abstract: OBJECTIVE
  To determine whether sex- and ethnicity-based mortality differences in patients dependent on hemodialysis (hemodialysis patients) are because of prevalence of vascular access type.
  
  
  METHODS
  Southern California Permanente Medical Group Renal Database, which contained 5821 chronic hemodialysis patients between 2000 and 2008, was studied.
  
  
  RESULTS
  Mean age of the patients was 62 years, and 59% were male. Of the population, 33% were white; 32%, Hispanic; 23%, African American; 9%, Asian/Pacific Islander; and 3%, other race or ethnicity. Predominant access type over the course of the study was arteriovenous fistula (AVF) in 73%, arteriovenous graft (AVG) in 12%, and tunneled catheter in 14%. There was a higher percentage of AVF in whites (71%) than in African Americans (63%). Risk of death was independently increased by age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.04-1.05), male sex (HR, 1.33; 95% CI, 1.22-1.45), diabetes (HR, 1.22; 95% CI, 1.12-1.33), use of an AVG (HR, 1.51; 95% CI, 1.34-1.71) or a tunneled catheter (HR, 6.45; 95% CI, 5.78-7.20). Compared with whites, African-American race decreased the risk of death (HR, 0.63; 95% CI, 0.56-0.70), as did Asian/Pacific Islander (HR, 0.58; 95% CI, 0.49-0.69), Hispanic (HR, 0.58; 95% CI, 0.51-0.65), and other race (HR, 0.67; 95% CI, 0.52-0.86).
  
  
  CONCLUSIONS
  Age, sex, race or ethnicity, access type, and diabetes are independent risk factors for mortality in hemodialysis patients. After controlling for potential confounders, when compared with whites, minorities all demonstrate significantly decreased risk of mortality. African Americans had reduced mortality risk despite a lower prevalence of arteriovenous fistula compared with whites. Male sex increased mortality. Differences in mortality between sexes and ethnicities in this population cannot be accounted for by differences in type of dialysis access.
authors: University of Southern California, Los Angeles, USA. karen.woo@surgery.usc.edu
authors: Karen
authors: K
authors: Woo
authors: Janis
authors: J
authors: Yao
authors: David
authors: D
authors: Selevan
authors: Robert J
authors: RJ
authors: Hye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality*; D002140:California / Q000453:epidemiology; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult