Minority Patients Have Lower Rates of Fistula Access

African American and Hispanic patients are less likely to have an arteriovenous fistula (AVF) in place when starting hemodialysis, compared to white patients with similar characteristics, reports a study in JAMA Surgery.

The analysis included US Renal Data System data on 396,075 patients initiating hemodialysis from 2006 through 2010. Multivariable analysis and propensity-score matching were used to compare hemodialysis access rates—including AVF, arteriovenous graft, and intravascular hemodialysis catheter—for patients of different racial/ethnic groups but otherwise similar characteristics.

An AVF was in place at the start of hemodialysis for 18.3 percent of white patients, compared to 15.5 percent of African American and 14.6 percent of Hispanic patients. This was so even though the minority patients were younger and had lower rates of comorbid conditions: coronary artery disease, chronic obstructive pulmonary disease, and cancer.

Odds ratios for AVF access were 0.90 for uninsured and 0.85 for insured African American patients, and 0.72 for uninsured and 0.81 for insured Hispanic patients. The difference was significant even among the subgroup of patients who had been under a nephrologist’s care for more than one year: odds ratio 0.81 for African American and 0.86 for Hispanic patients.

The results show persistent racial/ethnic disparities in the presence of an AVF for initial hemodialysis access in the United States. The lower rates of AVF access among African American and Hispanic patients are independent of insurance status, nephrology care, and other factors driving fistula placement. “The sociocultural underpinnings of these disparities deserve investigation and redress to maximize the benefits of initiating hemodialysis via fistula in patients with end-stage renal disease irrespective of race/ethnicity,” the investigators conclude [Zarkowsky DS, et al: Racial/ethnic disparities associated with initial hemodialysis access. JAMA Surg 2015; doi:10.1001/jamasurg.2015.0287].