Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

Author:

Arya Shipra,Melanson Taylor A.,George Elizabeth L.,Rothenberg Kara A.ORCID,Kurella Tamura Manjula,Patzer Rachel E.,Hockenberry Jason M.

Abstract

BackgroundDespite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC).MethodsTo better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013.ResultsAt 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft.ConclusionsFemale patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

Funder

National Center for Advancing Translational Sciences

US Department of Health and Human Services

Publisher

American Society of Nephrology (ASN)

Subject

Nephrology,General Medicine

Reference46 articles.

1. Contents

2. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Vascular Access: 2018. AJKD Submission Draft. April 2018. https://www.kidney.org/sites/default/files/kdoqi_vasc-access-review2019_v2.pdf. Accessed: October 1, 2019

3. Association of Hemodialysis Central Venous Catheter Use With Ipsilateral Arteriovenous Vascular Access Survival

4. How Can the Complications of Central Vein Catheters Be Reduced?

5. The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3