Kidney Week

Abstract: SA-PO0438

Predialysis Nephrology Care and Incident Vascular Access Outcomes: Unique Lessons from the US Asian Population

Session Information

• Dialysis: Vascular Access
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Ashutosh M. Shukla, MD, FASN

• Scheiffele, Grant D., University of Florida, Gainesville, Florida, United States

Grant D. Scheiffele, MPH

• Pramod, Sheena, University of Florida, Gainesville, Florida, United States

Sheena Pramod, MD, FASN

• Richiez Nieves, Paola A, University of Florida, Gainesville, Florida, United States

Paola A Richiez Nieves, MD

• Shettigar, Shruti Kishor, University of Florida, Gainesville, Florida, United States

Shruti Kishor Shettigar, MBBS, MD

• Parmar, Cydney El Cid, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Cydney El Cid Parmar, MPH

• Huang, Wenxi Huang, University of Florida, Gainesville, Florida, United States

Wenxi Huang Huang, MS

• Liu, Mei, University of Florida, Gainesville, Florida, United States

Mei Liu, PhD

• Xu, Qi, University of Florida, Gainesville, Florida, United States

Qi Xu, PhD

• Guo, Yi, University of Florida, Gainesville, Florida, United States

Yi Guo, PhD

• Guo, Serena Jingchuan, University of Florida, Gainesville, Florida, United States

Serena Jingchuan Guo, MD, PhD

Background

While various patient and provider-related barriers are believed to contribute, studies in US minorities show that system-related unequal access to pre-dialysis renal care attributes to 30-50% of incident vascular access disparities. Compared to White, US Asian patients have higher rates of incident vascular access rates. Understanding interplay of pre-dialysis renal care to incident vascular access among Asian patients can help better estimate its importance.

Methods

Analyzing 2021 USRDS, we identified all adult patients with >6-month pre-dialysis Medicare initiating hemodialysis(IHD) between 2010-2019. Using a mediation analysis with 10-variable adjustment model, and self-reported race/ethnicity of Asian/non-Hispanic White as exposure, pre-dialysis renal care as mediator, we examined the attributable influence of system-based pre-dialysis renal care access on incident vascular access outcomes among Asian vs. White patients. We conducted extensive sensitivity analysis modulating the mediator duration.

Results

Of 427,340 eligible incident IHD patients, study cohort of 382,321 was isolated; 12,624(3%) Asian and 269,697(63%) non-Hispanic White patients. Any and >6-month pre-dialysis renal care was present in 180,428(64%), 139,885(48%) patients, respectively. Incident AVF/AVG was present in 51,332(18.2%), maturing AVF/AVG in 48,168(17%) and CVC-only in 182,277(65%) patients. Pre-dialysis renal care did not differ significantly between Asian and White patients but was associated with 12-fold(aOR:12.68, 95%Cl:12.01-13.39) higher odds of incident AVF/AVG and 3-fold(aOR:2.75, 95%Cl:2.66-2.84) higher odds of maturing AVF/AVG. Asian patients had 13%(95%CI:7-9%) higher rates of incident AVF/AVG, and 10%(95%CI:4-16%) higher rates of maturing AVF/AVG(P<0.001). Mediation analyses showed that disparity in pre-dialysis renal care access mediated 17% of incident AVF/AVG underuse among Asian compared to White patients (P=0.0001). Sensitivity analysis confirmed primary findings. Pre-dialysis renal care did not have attributable influence on maturing access.

Conclusion

Our results emphasize the need for hypothesis-driven mechanistic studies to understand the attributable impact of outcome-predisposing factors.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025rv1j5ety