Abstract: TH-PO774

Racial and Gender Disparities in Initial Hemodialysis Access among Medicare Beneficiaries

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Arteriovenous (AV) access confers survival and economic benefits over catheters in incident hemodialysis (HD) patients. However, after considering the influence of pre-dialysis health status (defined as nephrology care and acute care hospitalizations), the effects of race and gender in the utilization of HD access is not known.

Methods

We evaluated 47,602 adult incident HD patients (1/1/2008 to 12/31/2008) from the United States Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to HD initiation. Information on pre-dialysis health status was obtained from form 2728 and linked Medicare claims. Using case-mix adjusted logistic regression models; we examined the effects of race and gender on type of vascular access (arteriovenous [AV] access vs. catheter) at HD initiation.

Results

The majority of patients were male (55%) and White (62%). Catheter was the dominant access method used to initiate HD (82% vs. 18% AV access). A higher rate of Blacks (19%) and Asians (19%) initiated HD with AV access than did Whites (17%), Native Americans (16%) or Hispanics (15%) (unadjusted p<0.001). Pre-dialysis nephrology care was received by 58% of patients; and was associated with higher rate of AV access for initial HD than those without pre-dialysis nephrology care (27% vs. 4%, p<0.001). Acute hospitalization during the 2 years prior to HD initiation occurred in 89% of patients; and was associated with lower rate of AV access than those without pre-dialysis acute hospitalization (15% vs. 40%, p<0.001). In adjusted analyses, Blacks were more likely than Whites (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.17) and Hispanics were less likely than Whites (OR, 0.82; CI, 0.74-0.90) to initiate HD with AV access. Similarly, females were less likely to initiate HD with AV access than were males (OR, 0.83; CI, 0.72-0.87).

Conclusion

Among Medicare beneficiaries’, Blacks are more likely than Whites to use AV access for first outpatient HD; whereas Hispanics are less likely than Whites and females are less likely than males to initiate HD with AV access. These differences across race and gender are independent of pre-dialysis health status, among other factors. Further investigation of biological and process of care factors is warranted to reduce these disparities.