Abstract: SA-PO047
Racial and Ethnic Differences in Arteriovenous Access (AVA) Use One Year After Hemodialysis (HD) Initiation with a Central Venous Catheter (CVC)
Session Information
- Diversity and Equity: Other Research
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Worsley, Melandrea L., Baylor College of Medicine, Houston, Texas, United States
- Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
- Erickson, Kevin F., Baylor College of Medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
- Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
Background
Racial and ethnic differences exist in AVA use, which includes AV fistulas and grafts, at HD initiation. We evaluated temporal trends in racial/ethnic differences in AVA use and anatomic location 1 year after HD initiation among those who had initiated HD with a CVC.
Methods
Using data from a large dialysis organization (LDO), we identified patients who initiated HD with a CVC between 2006 and 2016 and who remained on HD with same LDO for 1 year. Race/ethnicity (hereafter referred to as race) was categorized as Black, Hispanic, White, & Other. The use of an AVA within 1 year after HD initiation was plotted by calendar year, Annual racial differences in proportions with AVA were assessed using logistic regression, adjusted for demographics and comorbidities, and changes over time were assessed using a race x calendar year interaction term. Anatomic locations of AVA were defined as lower arm, upper arm, or other/missing/multiple locations.
Results
Of 198,186 participants, 67,315 (34%) were Black, 31,711 (16%) Hispanic, 86,117 (43%) White, and 13,043 (7%) were of other races/ethnicities. Compared to White patients, Black, Hispanic, and Other patients were younger and less likely to have heart failure or peripheral arterial disease, whereas the Hispanic and Other groups were more likely to have diabetes than Black and White patients. From 2006 to 2016, use of an AVA within 1 year increased in all racial/ethnic groups (P<0.001), with race x calendar year interaction at P=0.01 (Figure 1A). Compared to White patients, Black patients had similar odds of using an AVA within 1 year, while those of Other race were consistently more likely and the Hispanic group was at times more likely than Whites. However, Black patients were less likely to use an AVA placed in the preferred location in the lower arm than the other groups (Figure 1B).
Conclusion
Although there has been an improvement in AVA use at 1 year after initiation of HD with a CVC in all racial groups, differences in AVA use and location remain and warrant further investigation.
Funding
- NIDDK Support