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Abstract: FR-PO859

Racial and Ethnic Disparities in the Anatomic Location of Arteriovenous Access (AVA) for Hemodialysis (HD) Initiation

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Worsley, Melandrea L., Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Erickson, Kevin F., Baylor College of Medicine, Houston, Texas, United States
  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
  • Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
Background

Racial/ethnic disparities have been shown in the type of AVA (arteriovenous fistula [AVF] vs graft [AVG]) used at incident HD. We evaluated racial and ethnic disparities in the anatomic location of HD AVA in the U.S.

Methods

Using the clinical records of a large dialysis organization we evaluated patients ≥16 years old with incident end-stage kidney disease who initiated outpatient center HD via an AVF or AVG between 2006-2021. Individuals who initiated HD via a catheter, had multiple access types/locations reported at incident HD, were on peritoneal dialysis, or had a kidney transplant were excluded. Race/ethnicity was categorized as White, Black, Hispanic, or other. Access location was defined as forearm vs non-forearm. Multivariable logistic regression estimated associations of race/ethnicity with AVA forearm location and trends over time in AVA location using race x year interaction terms.

Results

Of 42,373 participants, 22,596 were White, 10,729 were Black, 5,054 were Hispanic, and 3,994 were other races; 61% had diabetes and 6% had heart failure. There was a decrease in HD initiation via a forearm AVA over time in all race/ethnicity groups (Figure 1A). In 2006, 48% had a forearm AVA, compared to 28% in 2021. An omnibus test for interaction of race x calendar time was significant (p=.006). In 2021, Black patients were 24% (95% CI, 16%-31%) less likely and Hispanic patients were 19% (95% CI, 8%-28%) less likely than White patients to initiate HD with a forearm AVA; these findings were consistent within the AVF and AVG subgroups (Figure 1B). Other races were 23% (95% CI, 8%-41%) more likely than White patients to initiate HD with a forearm AVA.

Conclusion

Racial disparities exist in the anatomic location of AVA used for initiation of outpatient HD with Black and Hispanic patients being less likely than White patients to have a forearm location. Use of forearm AVA, generally the preferred anatomic location, has decreased over time across all racial/ethnic groups. Further investigation is needed into factors influencing these disparities and temporal trends.