Association Of Race And Ethnicity With Initial Surgical Hemodialysis Access Type In A Safety Net System
Maria G. Valadez, MD.
Harbor UCLA Medical Center, Torrance, CA, USA.
OBJECTIVES: Prior studies have found lower rates of arteriovenous fistula (AVF) creation in Black and Hispanic patients. Whether this is due to health care disparities or other differences is unclear. Our objective was to evaluate the racial/ethnic differences in initial surgical access type within a high volume, safety net system with predominantly Hispanic and Black populations.
METHODS: A retrospective review of initial hemodialysis access in consecutive cases between 2014 and 2019 was conducted from all five safety net hospitals in a health care system that primarily treats underserved patients. Patient data collected included race, ethnicity, sex, co-morbidities, and initial AV access type (AVF vs AV Graft (AVG). Rates of cephalic vein (CAVF) based (radiocephalic, brachiocephalic) AVF were compared to basilic and brachial vein AVF (BAVF), as the latter are performed as two stages. Bivariate and multivariate logistic regression models were adjusted for demographic and clinical variables and used to evaluate the relationship of race/ethnicity, surgical access type, and comorbid conditions. RESULTS:1334 patients (74% Hispanic, 9% Black, 7% Asian, 2% White, 8% other) underwent first-time surgical hemodialysis access creation. The majority were male 818 (63%). Medical comorbidities were equal among groups, except for COPD and stroke which were higher in Blacks (p=0.000 and p=0.007, respectively). Dialysis was initiated with central venous catheter (CVC) in 68%, (Black 58%, Latino 71%, Asian 63%, white 74%, p=.005). Overall, 1303 (98%) underwent AVF creation and only 31 AVG (2%) with no difference between race/ethnicity in AVF vs AVG creation. Of the AVF cohort, 991 (76%) had a CAVF and 312 (24%) had a BAVF. Hispanics and Asians were twice as likely to undergo CAVF than BAVF as compared to black patients, independent of medical comorbidities, p=0.003. Males were also more likely than females to get a CAVF (65% vs 35%, p= 0.001). CONCLUSIONS: Within our safety net health system, in which the majority of patients are underrepresented minorities, nearly all patients undergoing hemodialysis access had an AVF as their initial surgery with no difference in race/ethnicity. HD initiation with CVC was also lower than the 80% national average. AVF type differed by race, with black patients twice as likely to undergo BAVF which required two stages. Further studies are needed to identify the reasons for these differences.
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