The Effect Of Race On Arteriovenous Graft Outcomes In A Veteran Dialysis Patient Population
Diana Otoya, MD, Kedar S. Lavingia, MD, Marc Posner, MD, Michael F. Amendola, MD, MEHP.
Virginia Commonwealth Univsersity, Richmond, VA, USA.
OBJECTIVES: Arteriovenous graft placement (AVG) is an established secondary hemodialysis access procedure. Previous studies have identified racial disparity as a confounding variable in hemodialysis access outcomes. We sought to examine our arteriovenous graft outcomes based on patient racial demographics in our veteran patient population.
METHODS: We retrospectively query our Veterans Administration Hospital dialysis access database from January 1, 2006 to January 1, 2018 to identify all diabetic patients who had AVG placement in the upper extremity. We followed outcomes until April 1, 2019 after AVG placement. Patients were stratified by race: African American (AA) and Caucasian (C). Outcomes examined included successful cannulation, functional patency (successful needle cannulation and usage for dialysis), thrombosis events and endovascular interventions per access. We also examined previous access procedures. Statistical analysis included t-test* and Fishers Exact test.**
RESULTS: A total number 98 AVG were placed in 98 male patients (TABLE 1).
There were no statistical differences found in regard to previous access, hypertension, smoking history, platelet, BUN, hemoglobin, statin use, antiplatelet prescription, or anticoagulation. Caucasian patients had statistically significant higher BMI (27.2 ± 6.0 vs. 30.6 ± 7.0; p=0.02*), glucose (107 ± 36 vs. 165 ± 72; p=0.0001*), and older age (63.7 ± 10.4 vs. 70.0 ± 7.8; p=0.004*) compared to African American patients respectively.
CONCLUSIONS: Contrary to previous studies, we found similar functional outcomes regardless of race. The C group had higher comorbidities (BMI, glucose, creatinine and older age) compared to the AA group. Future prospective large population base studies will be necessary to further elucidate the effects of racial disparity on functional outcomes of arteriovenous grafts in hemodialysis patients.
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