Abstract: SA-OR024
A Decade in Decline: United States Renal Data System Analysis of Vascular Access Trends at Hemodialysis Initiation by Gender, Race, Age, and Insurance
Session Information
- Dialysis Vascular Access: From Basic Discovery to Translational Science
November 08, 2025 | Location: Room 342D, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Tripathi, Ohm S., University of Connecticut, Storrs, Connecticut, United States
- Kidd, Jason M., Virginia Commonwealth University, Richmond, Virginia, United States
- Paulus, Amber B., Virginia Commonwealth University, Richmond, Virginia, United States
Background
Optimal chronic hemodialysis (HD) vascular access aims to provide reliable circulation access while minimizing complications for patients with end-stage kidney disease (ESKD). The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines favor arteriovenous fistulas (AVFs) and grafts (AVGs) over central venous catheters (CVCs) due to lower risks of infection, failure, and central vein stenosis.
Methods
United States Renal Data System (USRDS) data from 2013–2022 were analyzed to evaluate initial HD access by gender, race/ethnicity, age, and insurance status. The impact of the coronavirus disease 2019 (COVID-19) pandemic was assessed by comparing pre-COVID (2017–2019) and post-COVID (2020–2022) trends.
Results
CVCs were the most common access (66.3%), followed by AVFs (15.4%) and AVGs (2.9%). AVF use declined 26.3%, reaching 12.2% in 2021. CVC use peaked at 74.3% in 2022. Black patients had the largest AVF decline (−31%); Native American patients had the largest CVC increase (+37.6%). AVG use remained stable, highest in Black patients (4.2%), and lowest in Native American (1.8%) and Hispanic (1.7%) groups. Post-COVID, AVF use declined for White (−2.5%), Black (−2.8%), and Hispanic (−2.4%) patients; CVC use increased for all groups (White: +6.7%, Black: +8.3%, Hispanic: +7.0%, Asian: +8.5%, Native American: +9.5%). AVF use declined for both females (−25.4%) and males (−27.8%), narrowing the gender gap by 37% (p<0.001). CVC use increased for both sexes, narrowing the gap by 69% (p<0.001). AVG use was consistently higher among females (p<0.001). AVF use declined across all age groups, most sharply in ages 18–44 (−41.0%). CVC use rose in all age groups, highest in ages 45–64 (+26.7%). Most AVF and CVC differences by age were statistically significant (p<0.01). AVF use was highest in Medicare Advantage only (15.6%) and lowest in dual-eligible patients (11.2%); CVC use was highest in dual-eligible (~74%) and lowest in Medicare Advantage (69.6%). AVG use was stable (~3%) across insurance types, with no significant differences.
Conclusion
Despite national targets, CVC use at HD initiation has steadily increased over the past decade. The COVID-19 pandemic further exacerbated disparities, highlighting an urgent need for early, equitable access planning.