Ethnic Differences in Arteriovenous Fistula Initiation

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Lower odds of initiating hemodialysis with artervenous fistula for black and Hispanic versus white patients.
Lower odds of initiating hemodialysis with artervenous fistula for black and Hispanic versus white patients.

(HealthDay News) -- Black and Hispanic patients are significantly less likely to initiate hemodialysis with arteriovenous fistula (AVF), compared with white patients, according to a study published online in JAMA Surgery.

Devin S. Zarkowsky, M.D., from the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues conducted a retrospective analysis of 396,075 patients with end-stage renal disease in the U.S. Renal Data System, who started hemodialysis from 2006 through 2010. The authors assessed utilization of AVF, arteriovenous graft, and intravascular hemodialysis catheter.

The researchers found that more white patients initiated hemodialysis with an AVF than black patients or Hispanic patients (18.3 versus 15.5 and 14.6%, respectively; P < 0.001). Despite being younger and having less coronary artery disease, chronic obstructive pulmonary disease, and cancer than white patients with an AVF, black patients less frequently initiated hemodialysis with an AVF. 

In analyses stratified by medical insurance status, initiation of hemodialysis with an AVF was less frequent for black patients (odds ratios, 0.90 for uninsured and 0.85 for insured) and Hispanic patients (odds ratios, 0.72 for uninsured and 0.81 for insured) compared with white patients (P < 0.05 for all).

"The sociocultural underpinnings of these disparities deserve investigation and redress to maximize the benefits of initiating hemodialysis via fistula in patients with end-stage renal disease irrespective of race/ethnicity," the authors write.

Sources

  1. Zarkowsky, DS, et al. JAMA Surg. Published online April 29, 2015; doi:10.1001/jamasurg.2015.0287.
  2. Laura A. Peterson, MD; Matthew A. Corriere, MD. JAMA Surg. Published online April 29, 2015; doi:10.1001/jamasurg.2015.0321.
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