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Disparities in arteriovenous fistula placement in older hemodialysis patients
Author(s) -
Patibandla Bhanu K.,
Narra Akshita,
DeSilva Ranil,
Chawla Varun,
Vin Yael,
Brown Robert S.,
GoldfarbRumyantzev Alexander S.
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12099
Subject(s) - medicine , hemodialysis , arteriovenous fistula , dialysis , end stage renal disease , nephrology , central venous catheter , home hemodialysis , referral , logistic regression , cohort , emergency medicine , intensive care medicine , surgery , catheter , family medicine
The benefits of an arteriovenous fistula ( AVF ) as the preferred vascular access for hemodialysis have been clearly demonstrated. However, only about 20% of patients in the U nited S tates initiate hemodialysis with an AVF . In this study, we assessed whether disparities exist in the type of first hemodialysis access placed prior to dialysis start (rather than that used at dialysis initiation), to detect whether certain disadvantaged groups might have lower likelihood of AVF placement. Study cohort of 118,767 incident hemodialysis patients ≥67 years of age (1/2005–12/2008) derived from the U nited S tates Renal Data System was linked with Medicare claims data to identify the type of initial access placed predialysis. We used logistic regression model with outcome being the initial predialysis placement of an AVF as opposed to an arteriovenous graft or a central venous catheter. Increasing age, female sex, black race, lower body mass index, urban location, certain comorbidities, and shorter pre–end‐stage renal disease nephrology care are all associated with a significantly lower likelihood of AVF placement as initial access predialysis. Our study suggests the presence of significant disparities in the placement of an AVF as initial hemodialysis vascular access. We suggest that additional attention should be paid to these patient groups to improve disparities by patient education, earlier referral, and close follow‐up.