Racial and Gender Differences in Arteriovenous Fistula Use among Incident Hemodialysis Patients

Wasse, Haimanot; Hopson, Sari; McClellan, William M.

doi:10.1159/000318152

Cited by 41 publications

(49 citation statements)

References 45 publications

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“…It is possible that the very ability to create an AVF or AVG is associated with favorable vascular health and that the inability to create an AVF or AVG may have been a factor in the selection of PD for some patients. 23 However, in our cohort, HD-AVF/AVG patients had improved survival despite being older and having a higher burden of documented comorbidities as compared with PD patients. Moreover, our findings remained robust to several sensitivity analyses.…”

Section: Discussionmentioning

confidence: 59%

Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival

Perl

Wald

McFarlane

et al. 2011

Journal of the American Society of Nephrology

262

211

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Several comparisons of peritoneal dialysis (PD) and hemodialysis (HD) in incident patients with ESRD demonstrate superior survival in PD-treated patients within the first 1 to 2 years. These survival differences may be due to higher HD-related mortality as a result of high rates of incident central venous catheter (CVC) use or due to an initial survival advantage conferred by PD. We compared the survival of incident PD patients with those who initiated HD with a CVC (HD-CVC) or with a functional arteriovenous fistula or arteriovenous graft (HD-AVF/AVG). We used multivariable piece-wise exponential nonproportional and proportional hazards models to evaluate early (1 year) mortality as well as overall mortality during the period of observation using an intention-to-treat approach. We identified 40,526 incident adult dialysis patients from the Canadian Organ Replacement Register (2001Register ( to 2008. Compared with the 7412 PD patients, 1-year mortality was similar for the 6663 HD-AVF/AVG patients but was 80% higher for the 24,437 HD-CVC patients (adjusted HR, 1.8; 95% confidence intervals [CI], 1.6 to 1.9). During the entire period of follow-up, HD-AVF/AVG patients had a lower risk for death, and HD-CVC patients had a higher risk for death compared with patients on PD. In conclusion, the use of CVCs in incident HD patients largely accounts for the early survival benefit seen with PD.

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Section: Discussionmentioning

confidence: 59%

Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival

Perl

Wald

McFarlane

et al. 2011

Journal of the American Society of Nephrology

262

211

View full text Add to dashboard Cite

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“…There may also be other unmeasured factors, such as environmental exposures, markers of oxidative stress, apoptosis, and/or selected genetic polymorphisms, that could influence disease progression and/or risk of death across subgroups (30). Finally, many studies suggest that blacks receive less pre-ESRD care (9,15), which could lead to a survivorship bias in ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…Although black patients initiate maintenance dialysis at a younger age (4), they are less likely to receive kidney transplants, the treatment of choice in ESRD (8). In addition, when on dialysis, they are less likely to receive arteriovenous fistula placement (9) and adequate dialysis dose (10). Despite worse outcomes in these key clinical performance measures, black patients on dialysis had better survival than their white counterparts.…”

Section: Introductionmentioning

confidence: 99%

The Relationship of Age, Race, and Ethnicity with Survival in Dialysis Patients

Gao

Norris

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Reports on the racial and ethnic differences in dialysis patient survival rates have been inconsistent. The literature suggests that these survival differences may be modified by age as well as categorizing white race as inclusive of Hispanic ethnicity. The goal of this study was to better understand these associations by examining survival among US dialysis patients by age, ethnicity, and race. Design, setting, participants, & measurements Between 1995 and 2009, 1,282,201 incident dialysis patients ages 18 years or older were identified in the United States Renal Data System. Dialysis survival was compared among non-Hispanic blacks, non-Hispanic whites, and Hispanics overall and stratified by seven age groups. Results The median duration of follow-up was 22.3 months. Compared with non-Hispanic whites, a lower mortality risk was seen in Hispanics in all age groups. Consequently, when Hispanic patients were excluded from the white race, the mortality rates in white race all increased. Using non-Hispanic whites as the reference, a significantly lower mortality risk for non-Hispanic blacks was consistently observed in all age groups above 30 years (unadjusted hazard ratios ranged from 0.70 to 0.87; all P<0.001). In the 18- to 30-years age group, there remained an increased mortality risk in blacks versus non-Hispanic whites after adjustment for case mix (adjusted hazard ratio=1.19, 95% confidence interval=1.13–1.25). Conclusions The mortality risk was lowest in Hispanics, intermediate in non-Hispanic blacks, and highest in non-Hispanic whites. This pattern generally holds in all age groups except for the 18- to 30-years group, where the adjusted mortality rate for non-Hispanic blacks exceeds the adjusted mortality rate of non-Hispanic whites.

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“…There are also racial and ethnic differences in the processes of care, including dialysis dose (6,7), anemia treatment (8,9), hemodialysis vascular access (10)(11)(12)(13), and pre-ESRD clinical care (12,14). Prior studies examining hospitalization in dialysis patients usually used race, among others, as an explanatory factor or control variable (15)(16)(17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

Gao

Norris

Greene³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Although patients undergoing maintenance hemodialysis have exceptionally high hospitalization rates, the risk factors for hospitalizations are unclear. This study sought to examine hospitalization rates among hemodialysis patients in the United States according to both race/ethnicity and age.Design, setting, participants, & measurements US Renal Data System data on 563,281 patients beginning maintenance hemodialysis between 1995 and 2009 were analyzed. Rates of hospital admission and number of hospital days for all-cause and cause-specific hospitalizations during the first year of dialysis were compared among blacks, whites, and Hispanics in the entire cohort and subgroups stratified by age.Results After multiple adjustments, compared with whites, Hispanics overall had lower rates of both all-cause hospital days (adjusted rate ratio [aRR], 0.91; 95% confidence interval [95% CI], 0.90 to 0.93; P,0.001) and hospital admissions (aRR, 0.89; 95% CI, 0.88 to 0.90; P,0.001), whereas blacks had a lower rate of all-cause admissions (aRR, 0.95; 95% CI, 0.94 to 0.96; P,0.001). The racial/ethnic differences, however, varied by age. Hispanics exhibited the lowest rates of hospital days and admissions for all age groups#70 years, but those .80 years had higher rates than their white counterparts. The adjusted black-to-white rate ratios exhibited a U-shaped pattern with age, with higher rates for blacks in the younger and older age groups. Hospitalization rates for dialysisrelated infections were markedly higher in blacks and Hispanics than whites, which were consistent in all age groups for blacks (aRRs for hospital days ranged from 1.09 to 1.36) and all ages.60 years for Hispanics (aRRs ranged from 1.20 to 1.38).Conclusions There are significant racial/ethnic differences in hospitalization rates within first year of dialysis, which are not consistent across the age groups and also differ by causes of hospitalization. Overall, blacks and Hispanics had lower rates of all-cause hospital admissions than whites. However, younger and older blacks and older Hispanics were at greatest risk.

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Racial and Gender Differences in Arteriovenous Fistula Use among Incident Hemodialysis Patients

Cited by 41 publications

References 45 publications

Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival

Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival

The Relationship of Age, Race, and Ethnicity with Survival in Dialysis Patients

Race/Ethnicity, Age, and Risk of Hospital Admission and Length of Stay during the First Year of Maintenance Hemodialysis

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