Rates of arteriovenous fistula (AVF) placement in patients approaching hemodialysis in the United States are significantly lower in metropolitan than micropolitan areas, researchers reported online ahead of print in Hemodialysis International.

A micropolitan area, which is a federal designation created in 2003, is defined as an urban area based around an urban cluster with a population of 10,000 to 49,999.

In an analysis of data in the U.S. Renal Data System database (2005-2008) linked to Medicare claims (2003-2008), Alexander S. Goldfarb-Rumyantzev, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues found that AVF placement rates in metropolitan, micropolitan, and rural areas were 18.5%, 22.4%, and 21.6%, respectively.

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Patients in metropolitan areas had a significant 20% decreased likelihood of AVF placement compared with those in micropolitan. The study found no significant difference in AVF placement rates between metropolitan and rural areas.