Earlier Vascular Access Seen in Insured Dialysis Patients

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Patients with Medicare, Medicaid more likely to use arteriovenous fistula, graft by fourth dialysis month.
Patients with Medicare, Medicaid more likely to use arteriovenous fistula, graft by fourth dialysis month.

(HealthDay News) -- Patients with Medicare or Medicaid are more likely than uninsured patients to use an arteriovenous fistula or graft by their fourth dialysis month, according to a study published online Nov. 1 in the Clinical Journal of the American Society of Nephrology.

Eugene Lin, MD, from the Stanford University School of Medicine in Palo Alto, Calif., and colleagues noted that uninsured patients become Medicare-eligible by their fourth dialysis month. The authors conducted a retrospective cohort study to compare uninsured patients starting in-center hemodialysis with a central venous catheter between 2010 and 2013 to similar patients with Medicare or Medicaid coverage.

The researchers found that the likelihood of switching to an arteriovenous fistula or graft by the fourth dialysis month was increased for patients with Medicare or Medicaid versus uninsured patients (hazard ratios, 1.63 for Medicare and 1.23 for Medicaid). After all patients obtained Medicare in their fourth dialysis month, there were no significant differences in the rates of switching to arteriovenous fistulas or grafts. Fewer hospitalizations involving vascular access infection were seen in dialysis months 4 to 12 for patients with Medicare at dialysis start (hazard ratio, 0.6).

"Coverage for vascular access care among the uninsured population before the fourth month of dialysis could yield increased arteriovenous fistula and arteriovenous graft use and lead to improvements in patient health and health care costs," the authors write.

Reference

Lin E, Mell MW, Winkelmayer WC, and Erickson KF. Health Insurance in the First 3 Months of Hemodialysis and Early Vascular Access. Clin J Am Soc Nephrol. November 2018, CJN.06660518; DOI:10.2215/CJN.06660518

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