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Kidney Week

Abstract: FR-PO475

Dialysis Access: A Post-Code Lottery? A Single-Centre Retrospective Review

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Deoraj, Stuart R., Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Wadsworth, Bethany Jane Frances, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Vanniasegaram, Divyen, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Abbas, Allifia, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
Background

For many chronic diseases there is a clear relationship between social deprivation, health literacy, healthcare access and delayed presentation with disease progression. Outcomes of renal replacement therapy (RRT) may be affected by patient deprivation influencing delays in diagnosis, provision of pre-dialysis education and optimal dialysis access, resulting in line sepsis, central venous occlusion and inferior dialysis clearance. This study explores the influence of patient deprivation on the provision of dialysis access in a cohort of patients, using a 7-point deprivation index linked to patient postcode (IMD2019).

Methods

Data on 1600 haemodialysis patients aged 18+ was gathered from 2015 to present day, from an urban and peri-urban catchment area. Demographic data, initiation date on RRT, mode of dialysis access at initiation and 1 year follow up were analysed with respect to the individual patient’s IMD2019.

Results

Data from 308 patients was analysed. Mean age was 64 years, 64% (198) male and 50% Caucasian. A tendency towards lower levels of deprivation was noted, 16% of the cohort belonging to the least deprived decile. 207 (67%) patients commenced dialysis via a tunnelled line. At 1 year of dialysis, 88 (29%) of patients remained using a dialysis line. There was no statistically significant difference between IMD2019 for mode of access at initiation or the probability of having a fistula formed following dialysis initiation (χ2 1.6618, p 0.798). The length of time from dialysis initiation to successful fistula formation was 7.5 months for deprivation deciles 1 and 2 (most deprived), 13 months for decile 10 (least deprived). Patients in decile 10 spent on average, 29 months on dialysis, compared to 55 months in decile 2. Deprivation deciles 5 and 6 performed marginally better than deciles 1 and 10 on the rates of access to fistula surgery (relative risk 1.2, p 0.1).

Conclusion

This dataset does not demonstrate a statistically significant impact of deprivation on the first or final mode of vascular access among haemodialysis patients. However, there are significant biases. The study was conducted in a predominantly low deprivation, Caucasian cohort. There is a suggestion that lower decile patients were initiated earlier on dialysis and that middle-decile patients may have better access to fistulas compared to deciles 1 and 10.