Vascular access disparities for Hispanic adults with ESKD tied to pre-dialysis care gaps
Key takeaways:
- Hispanic patients were 64% less likely to receive pre-dialysis nephrology care vs. non-Hispanic white patients.
- Hispanic patients were 71% less likely to use an arteriovenous fistula or arteriovenous graft.
SAN DIEGO — Nearly one-third of disparities in vascular access outcomes for Hispanic vs. non-Hispanic white patients with end-stage kidney disease can be tied to pre-dialysis care inequities, data show.
Many “patients [who] require pre-dialysis nephrology care [may] need to have conversations with their nephrology care team to best understand access types. So, pre-dialysis nephrology care and further kidney replacement therapy-directed education is necessary for effective vascular access following a CKD diagnosis,” Grant D. Scheiffele, MPH, a health science specialist at the U.S. Department of Veterans Affairs in Gainesville, Florida, said during a presentation at ASN Kidney Week. “Unfortunately, research has shown disparities for the Hispanic population in these cases: They have lower rates of pre-dialysis nephrology care and lower rates of vascular access. However, we do not know to [what] extent the disparities in pre-dialysis care are attributable to those incident vascular access disparities.”
Scheiffele and colleagues analyzed United States Renal Data System data on 427,340 adult Medicare recipients who started hemodialysis between 2010 and 2019. They aimed to examine the impact of pre-dialysis disparities on incident vascular access.
Of the cohort, 46,146 patients were Hispanic and 269,697 were categorized as non-Hispanic white.
Among the cohort, 276,652 began treatment with a central venous catheter without an accompanying maturing arteriovenous fistula or arteriovenous graft, according to the researchers. Meanwhile, 75,238 initiated with an arteriovenous fistula or arteriovenous graft.
Hispanic patients were 64% less likely to receive pre-dialysis nephrology care and 71% less likely to use an arteriovenous fistula or arteriovenous graft vs. their non-Hispanic white peers.
Scheiffele and colleagues found the disparities influenced vascular access outcomes, with causal mediation analysis indicating 33% (95% CI, 29%-37%) of the incident vascular access underuse among Hispanic patients could be attributed to inequities in pre-dialysis care.
Further analyses suggested nephrology care beyond 6 months and enhanced kidney disease education could increase the likelihood of improved vascular access outcomes.
Researchers found in conclusion that “disparities that [exist in graft use] between ethnic backgrounds is attributed to these pre-dialysis nephrology care disparities,” Scheiffele said.
Collapse
Scheiffele GD, et al. TH-OR03. Presented at: ASN Kidney Week; Oct. 24-27, 2024; San Diego.