Healthcare Disparities Involved in Establishing Functional Arteriovenous Fistula Hemodialysis Access. Journal Article

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Authors: McDonnell, S; Frueh, J; Blecha, M; Aulivola, B; Halandras, PM
Article Title: Healthcare Disparities Involved in Establishing Functional Arteriovenous Fistula Hemodialysis Access.
Abstract: OBJECTIVES: Race-related disparities in outcomes associated with cardiovascular disease are well documented. Arteriovenous fistula maturation can be a challenge in establishing functional access in the end-stage renal disease population requiring hemodialysis. We sought to investigate the incidence of adjunctive procedures required to establish fistula maturation and evaluate the association with demographic factors including patient race. METHODS: This study was a single institution retrospective review of patients undergoing first-time arteriovenous fistula creation for hemodialysis from January 1, 2007 to December 31, 2021. Subsequent arteriovenous access interventions, such as percutaneous angioplasty; fistula superficialization; branch ligation and embolization; surgical revision; and thrombectomy, were recorded. The total number of interventions performed after index operation was recorded. Demographic data including age, sex, race and ethnicity was recorded. The need for and number of subsequent interventions was evaluated using multivariable analysis. RESULTS: A total of 669 patients were included in this study. Patients were 60.8% male and 39.2% female. Race was reported as White in 329 (49.2%), Black in 211 (31.5%), Asian in 27 (4.0%), and other/unknown in 102 (15.3%). 355 (53.1%) patients underwent no additional procedures after initial arteriovenous fistula creation, 188 (28.1%) underwent 1 additional procedure, 73 (10.9%) had 2 additional procedures, and 53 (7.9%) had 3 or more additional procedures. As compared to the White reference group, Black patients were at higher risk of having maintenance interventions (RR=1.900, p=0.0001) and additional AVF creation interventions (RR=1.332, p= 0.05), and total interventions (RR=1.551, p=0.0001). CONCLUSIONS: Black patients were at significantly higher risk of undergoing additional surgical procedures, including both maintenance and new fistula creations, as compared to their counterparts of other racial groups. Further exploration of the root cause of these disparities is necessary to facilitate the achievement of equivalent high quality outcomes across racial groups.
Journal Title: Journal of vascular surgery
ISSN: 1097-6809; 0741-5214
Publisher: Mosby, Inc  
Date Published: 2023