title: Disparities in arteriovenous fistula placement in older hemodialysis patients.
abstract: The benefits of an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis have been clearly demonstrated. However, only about 20% of patients in the United States initiate hemodialysis with an AVF. In this study, we assessed whether disparities exist in the type of first hemodialysis access placed prior to dialysis start (rather than that used at dialysis initiation), to detect whether certain disadvantaged groups might have lower likelihood of AVF placement. Study cohort of 118,767 incident hemodialysis patients ≥67 years of age (1/2005-12/2008) derived from the United States Renal Data System was linked with Medicare claims data to identify the type of initial access placed predialysis. We used logistic regression model with outcome being the initial predialysis placement of an AVF as opposed to an arteriovenous graft or a central venous catheter. Increasing age, female sex, black race, lower body mass index, urban location, certain comorbidities, and shorter pre-end-stage renal disease nephrology care are all associated with a significantly lower likelihood of AVF placement as initial access predialysis. Our study suggests the presence of significant disparities in the placement of an AVF as initial hemodialysis vascular access. We suggest that additional attention should be paid to these patient groups to improve disparities by patient education, earlier referral, and close follow-up.
authors.affiliation: Department of Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.
authors.forename: Bhanu K
authors.initials: BK
authors.lastname: Patibandla
authors.forename: Akshita
authors.initials: A
authors.lastname: Narra
authors.forename: Ranil
authors.initials: R
authors.lastname: Desilva
authors.forename: Varun
authors.initials: V
authors.lastname: Chawla
authors.forename: Yael
authors.initials: Y
authors.lastname: Vin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D006278:Medicare; D010353:Patient Education as Topic; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D014481:United States; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: Disparities; arteriovenous fistulae; elderly ESRD patients; ethnicity; gender difference