Minorities and socially vulnerable patients with end-stage kidney disease (ESKD) experience longer preoperative intervals between hemodialysis and surgery, according to new study findings published in JAMA Network Open.

Compared with a 0- or 1-day interval between the last hemodialysis session and surgery, a 2- or 3-day interval is associated with early death, lead author Vikram Fielding-Singh, MD, JD, of Stanford University School of Medicine in California explained in an interview with Renal & Urology News.

Using the US Renal Data System, Dr Fielding-Singh and his colleagues identified 338,391 patients who underwent 1,120,763 procedures. Among these surgeries, 81.9% involved a 0- or 1-day interval from the most recent hemodialysis session and 18.1% had a 2- or 3-day interval.

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Compared with patients aged 18 to 39 years, those aged 60 to 79 years and 80 years or older had significant 8% and 13% increased odds of a longer hemodialysis-surgery interval, respectively, in adjusted analyses. Women had significant 6% increased odds of a longer interval compared with men. Black adults had significant 17% increased odds of a longer interval compared with White adults.

As social deprivation index increased from low to high on a scale from 1 to 10, each decile was significantly associated with 2% increased odds of a longer interval between a hemodialysis session and surgery. The social deprivation index incorporates the percentage of people living in poverty, in rented housing units, in overcrowded housing, in single-parent households, with less than 12 years of education, without a car, and with unemployed adults younger than 65 years.

“Our study highlights the need for equitable access to perioperative care coordination for persons with ESKD,” Dr Fielding-Singh said.

He noted that health providers need to be aware of both disparities and implicit biases. The root causes of disparities may be specific to the communities and require tailored outreach, advocacy, and expanded access to care, he said. The National Institute on Minority Health and Health Disparities and the Centers for Disease Control and Prevention are researching ways to reduce such health disparities.

“The health care community is also learning how implicit forms of bias influence the care our patients receive in subtle ways. We, as a society, continue to learn how to counter ageism, sexism, and racism.”


Fielding-Singh V, Vanneman MW, Morris AM, Chertow GM, Lin E. Disparities in the timing of preoperative hemodialysis among patients with end-stage kidney disease. JAMA Netw Open. Published online July 28, 2023. doi:10.1001/jamanetworkopen.2023.26326