The Effect of Ethnicity on Arteriovenous Graft Outcomes
Michael F. Amendola, MD1, John Park, BS2.
1VA Medical Center/VCU Health System, Richmond, VA, USA, 2VCU School of Medicine, Richmond, VA, USA.
BACKGROUND
Arteriovenous graft placement (AVG) is an established secondary hemodialysis procedure. Some have called into question arteriovenous fistula outcomes in some ethic populations. We sought to examine our arteriovenous graft outcomes based on ethnicity.
METHODS
We retrospectively query our Veterans Administration Hospital dialysis access database from January 1, 2014 to August 1, 2017 to identify all patients who had AVG placement in the upper extremity. We followed outcomes until July 15 2018 for an additional 355 to 1515 days after AVG placement. Patients were stratified into race: African American (AA) and Caucasian (C). Outcomes examined including successful cannulation, functional utilization time (successful needle cannulation and usage on dialysis), thrombosis events and endovascular interventions per access. We also examined previous access procedures. Fisher’s Exact* and t-test** were utilized.
RESULTS
Total number 50 AVG were placed in 50 male patients (see table). AA and C patients did not have statistically significantly different mean number of previous arteriovenous access nor percent previous thrombosis events (1.0 +/- 1.0 vs. 0.73 +/- 0.81; p=0.34* and 52% vs. 50%; p=0.5*) respectively. Factors not found to be different between the two groups (hypertension, smoking history, patient age, platelet, hemoglobin, statin use, antiplatelet prescription, nor anticoagulation). AA and C patients had statistically significant differences in BMI (26.8 +/- 6.8 vs. 32.2 +/- 7.2; p=0.01**), glucose (103+/- 33 vs. 142 +/- 54; p=0.003**), creatinine (6.7 +/- 2.3 vs. 4.9 +/- 1.7; p=0.007**) and MCV (91.2 +/- 6 vs. 95.1 +/- 5.5; p=0.02**) respectively.
CONCLUSIONS
Caucasian patients undergoing AVG placement were found to have more interventions per access with similar functional outcomes. The Caucasian group had higher comorbidities (BMI, glucose, creatinine and MCV) compared to the African American patients. It is not clear if these factors or increased awareness/ surveillance is driving this practice.
| AA (n=31) | C (n=19) | p value | |
| Successful Cannulation | 21/31 (68%) | 16/19 (84%) | 0.3* |
| Functional Patency Once Accessed(mean days +/- SD) | 500 +/- 343 | 528 +/- 324 | 0.8** |
| Endovascular Interventions per Access (mean +/- SD) | 0.06 +/- 0.25 | 0.31 +/- 0.58 | 0.04** |
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