Among individuals with incident end-stage renal disease, women are less likely than men and Hispanics are less likely than whites to have arteriovenous access (AV) for hemodialysis (HD) initiation, new study findings suggest. Results also showed that whites have a significantly greater 1-year mortality risk than other racial groups.

Using the U.S. Renal Data System database, Silvi Shah, MD, from the Division of Nephrology at the University of Cincinnati in Ohio, and colleagues analyzed data from 885,699 patients with incident end-stage renal disease who initiated HD from January 1, 2004 to December 31, 2014. Women had 15% lower odds of arteriovenous (AV) access use at HD initiation than men in adjusted analyses, Dr Shah’s team reported in the American Journal of Nephrology (2018;48:4-14).

The study population, which was 56.3% male, had a mean age of 65 years. The racial composition was 53.2% white, 28.1% black, 13.7% Hispanic, 4.1% Asian, and 0.9% Native American. Overall, 17.5% of patients had AV access at HD initiation, but the proportion was slightly but significantly higher among men than women (18.5% vs 16.2%).

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Compared with white patients, black and Asian patients had 8% and 11% greater odds of AV use at HD initiation, respectively, whereas Hispanic patients had 11% decreased odds.

Asian men had the highest rate of AV access and Hispanic men had the lowest (21.1% vs 15.4%).

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The 1-year mortality rates were 30.6%, 19%, 17.8%, 16.8%, and 16.5% for whites, blacks, Hispanics, Asians, and Native Americans, respectively. Compared with whites, the 1-year adjusted mortality odds were 45%, 33%, 38%, and 38% lower among Asians, blacks, Hispanics, and Native Americans, respectively. The 1-year mortality rates for men and women were 24.8% and 25%, respectively, a non-significant difference.


Shah S, Leonard AC, Meganathan K, et al. Gender and racial disparities in initial hemodialysis access and outcomes in incidence end-stage renal disease patients. Am J Nephrol. 2018;48:4-14.