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Impact Of The Social Vulnerability Index, A Measure Of Health Disparity, On Dialysis Care
Mark G. Davies, MD PhD MBA
1, Joseph P. Hart, MD MHL
2.
1Ascension Health, Waco, TX, USA,
2MCW, Milwaukee, WI, USA.
Objective: Establishing long-term arteriovenous access is important in long-term care for patients with End-Stage Renal Disease (ESRD). Health disparities are reported to impact the access management of ESRD patients. This study aimed to analyze the impact of the Social Vulnerability Index (SVI) on the outcomes of primary dialysis access placement.
Methods: Between 2018 and 2022, all patients undergoing a primary access placement were analyzed. Patient addresses were geocoded, and estimated Social Vulnerability Index (SVI) scores were assigned. The cutoff for high
versus low social vulnerability risk was an SVI >75th percentile. SVI consists of 4 distinct disparity domains that allow for subgroup analysis: socioeconomic, minority status and language, household composition and disability, and housing and transportation. Outcomes of maturation (successful progression to HD), re-intervention, functional dialysis (continuous HD for three consecutive months), and patency were examined.
Results: 674 patients (64% female, mean age of 61±15yrs; mean±SD) underwent placement of arteriovenous fistula (AVF, 86%), peritoneal dialysis catheter (PD, 6%), arteriovenous graft (AVG, 4%) and long-term hemodialysis catheter (HC, 3%). At the time of access placement, 49% were considered high risk, and the remainder low risk. High-risk SVI was associated with ineligibility for PD placement and care and a greater likelihood for AVG and HD placement. The presence of a high-risk SVI impacted 30-day MACE, early thrombosis and time to maturation (Table 1). Furthermore the maintenance of access and the duration of functional dialysis was worse (Table 1).
| | | |
| Table 1 Outcomes | Low-Risk SVI | High-risk SVI | P-value |
| Patients (n) | 330 | 344 | |
| 30-day MACE | 4% | 8% | 0.01 |
| Early Thrombosis (<18days) ‡ | 3% | 10% | 0.004 |
| Intervention to achieve maturation ‡ | 15% | 28% | 0.002 |
| Maturation days ‡ (Mean ± SEM) | 74% | 55% | 0.02 |
| Secondary Interventions per year | 1.5 | 4.1 | 0.02 |
| Functional Dialysis @ 3yrs (Mean ± SEM) | 79% | 57% | 0.01 |
| ‡ excludes PD |
Conclusions: The
identification of a high health disparity risk as measured by the SVI impacts the choice of access and is associated with poor short-term and long-term outcomes after placement of dialysis access. Predetermination of health disparities is an important variable to consider in the establishment of long-term dialysis access care.
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