Disparities in Placement of Arteriovenous Access at Hemodialysis Initiation

Studies have shown that there are racial and ethnic disparities in the type of arteriovenous access (AVA)—arteriovenous fistula (AVF) versus arteriovenous graft (AVG)—used at incident hemodialysis. Melandrea L. Worsley, MD, and colleagues at Baylor College of Medicine, Houston, Texas, performed an analysis designed to assess racial and ethnic disparities in the anatomic location of hemodialysis AVA.

Results were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled Racial and Ethnic Disparities in the Anatomic Location of Arteriovenous Access (AVA) for Hemodialysis (HD) Initiation.

The researchers utilized clinical records of a large dialysis organization to evaluate patients ≥16 years of age with incident end-stage renal disease who initiated hemodialysis at an outpatient center. Eligible patients initiated hemodialysis via an AVF or an AVG between 2006 and 2021. Patients who initiated hemodialysis via catheter access, who had multiple access types/locations reported at incident hemodialysis, were on peritoneal dialysis, or had a kidney transplant were excluded from the analysis.

Race/ethnicity was categorized as White, Black, Hispanic, or other. Access location was identified as forearm or nonforearm. Associations of race/ethnicity with AVA forearm location were estimated using multivariable logistic regression. Race ´ year interaction terms were used to assess AVA location trends over time.

The eligible cohort included 42,373 participants. Of those, 22,596 were White, 10,729 were Black, 5054 were Hispanic, and 3994 were other races/ethnicities. Of the total cohort, 61% had diabetes and 6% had heart failure.

In all race/ethnicity groups, there was a decrease in hemodialysis initiation via a forearm AVA over time: in 2006, 48% had a forearm AVA compared with 28% in 2021. An omnibus test for interaction of race ´ calendar time was significant (P=.006).

In 2021, compared with White patients, Black patients were 24% (95% CI, 16%-31%) less likely to initiate hemodialysis with a forearm AVA, and Hispanic patients were 19% (95% CI, 8%-28%) less likely to initiate hemodialysis with a forearm AVA. The findings were consistent within the subgroups with AVF and AVG access. Patients of other races were 23% (95% CI, 8%-41%) more likely to initiate hemodialysis with a forearm AVA than White patients.

In summary, the researchers said, “Racial disparities exist in the anatomic location of AVA used for initiation of outpatient hemodialysis, 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.”

Source: Worsley ML, Winkelmayer WC, Erickson KF, Niu J, Gregg LP. Racial and ethnic disparities in the anatomic location of arteriovenous access (AVA) for hemodialysis (HD) initiation. FR-PO859. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.