Despite declining rates of vascular access complications among patients receiving hemodialysis in the United States, racial disparities remain, a new study finds.

“The findings in this study emphasize the need for more equitable care for hemodialysis patients,” Sanjay Misra, MD, of Vascular and Interventional Radiology at Mayo Clinic in Rochester, Minnesota, and colleagues wrote in Kidney International Reports.

In the 2005-2018 Healthcare Cost and Utilization Project – National Inpatient Sample, 1,167,886 of 9,246,553 total admissions involving hemodialysis (12.6%) included vascular access complications. Hemodialysis access creation with arteriovenous fistulas (AVF), central venous catheters (CVCs), or arteriovenous grafts (AVGs) are all susceptible to complications such as thrombosis, mechanical failure, infection, and stenosis.

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Dr Misra’s team found that the rates of mechanical complications (eg, mispositioning, leakage, or malfunction), inflammatory/infectious complications, and other complications (eg, hemorrhage, pain, stenosis, thrombosis, and embolism) significantly declined 0.05%, 0.48%, and 0.19% per year, respectively, from 2005-2018. The rate of having all 3 types of complications concurrently significantly decreased 0.66% per year.

Non-White patients especially experienced improvement in the overall rate of vascular access complications compared with White patients: -0.69% vs -0.57% per year. Nonetheless, Black vs White patients had significant 12%, 15%, and 35% increased odds of mechanical, inflammatory/infectious, and other complications, respectively, the investigators reported. Hispanic patients had significant 8% decreased odds of mechanical and inflammatory/infectious complications compared with White patients, but 7% increased odds of other complications. Patients of other non-White races also had 20% increased odds of other complications.

Black patients and those of other races also had significant 26% and 11% increased odds of composite complications, respectively. Compared with men, women had increased odds of all 3 types of complications individually and in composite. Composite complications were significantly associated with 24% increased odds of in-hospital mortality.

The majority of admissions involving access complications for hemodialysis occurred in the Southern United States (43.1%) and among patients in the lowest quartile of median household income (38.9%).

According to Dr Misra and colleagues, higher odds of complications among non-White racial groups may be due to comorbid conditions, inequity of pre-dialysis nephrology care, and differences in insurance statuses.

“A top-down and bottom-up effort, with reforms at societal levels and patient-level, respectively, is required to lower complication rates and improve hemodialysis maintenance.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wahood W, Takahashi E, Rajan D, et al. National trends in complications of vascular access for hemodialysis and analysis of racial disparities among patients with end-stage renal disease in the inpatient setting. Kidney Int Rep. Published March 19, 2023. doi:10.1016/j.ekir.2023.03.001