Kidney Week

Abstract: PO1040

Racial Disparities in Arteriovenous Fistula Use Among Hemodialysis Patients: The Role of Vascular Surgeon Availability

Session Information

• Vascular Access Arena: Challenges, Progress, and Prospects
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Vascular Access

Authors

• Zhang, Yi, Medical Technology and Practice Patterns Institute, Bethesda, Maryland, United States

Yi Zhang

• Thamer, Mae, Medical Technology and Practice Patterns Institute, Bethesda, Maryland, United States

Mae Thamer,

• Lee, Timmy C., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States

Timmy C. Lee,

• Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews,

• Allon, Michael, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States

Michael Allon,

Background

Factors contributing to persistent racial disparities in the use of arteriovenous fistulas (AVF) among HD patients are unclear. A recent study reported significant geographic variation in the availability or supply of vascular access (VA) surgeons. We examined whether racial disparity in AVF use is affected by VA surgeon availability.

Methods

Using CROWNWeb and Medicare claims data from the US Renal Data System (USRDS), longitudinal competing risk analyses of all adult outpatients initiating HD with a central venous catheter (CVC) in 2016 and 2017 (n=103,286) were performed. Likelihood of successful AVF use was compared between Black and White patients after adjusting for VA surgeons supply, calculated as the number of surgeons normalized by the number of HD patients in each hospital referral region (HRR).

Results

Patient, facility, and area characteristics varied significantly among different levels of surgeon supply. At month 12 of hemodialysis, 40% of patients who initiated with a CVC had successful AVF use. Compared to the 1^st quartile of surgeon supply, higher supply levels were associated with modestly increased likelihood of AVF use: 3% (95% CI 0.4-6.1%), 4% (95% CI 0.7-6.9%, and 3% (0.0-6.1%) for 2^nd, 3^rd, and 4^th quartiles, respectively. However, residing in areas with a greater surgeon availability was not associated with less racial disparity in likelihood of AVF use (Figure 1). Specifically, compared to White patients, Black patients were 10% (95% CI 7 to 13%) and 8% (95% CI 5 to 11%) less likely to have successful AVF use in low and high surgeon supply areas, respectively.

Conclusion

VA surgeon supply was not associated with racial disparities in AVF use among patients initiating with a CVC. Additional studies of patient, provider, practice, and regional factors are needed to identify relevant factors to mitigate lower rates of AVF use among Black HD patients.

Figure 1

Funding

• Other NIH Support