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

Authors
  • Arya, Shipra1, 2
  • Melanson, Taylor A3
  • George, Elizabeth L4
  • Rothenberg, Kara A4, 5
  • Kurella Tamura, Manjula6, 7
  • Patzer, Rachel E8, 9
  • Hockenberry, Jason M10
  • 1 Division of Vascular Surgery and [email protected]
  • 2 Division of Vascular Surgery, Surgical Services Line and.
  • 3 Division of Transplant, Department of Surgery, Emory School of Medicine.
  • 4 Division of Vascular Surgery and.
  • 5 Department of Surgery, University of California, San Francisco East Bay, Oakland, California.
  • 6 Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California.
  • 7 Division of Nephrology, Stanford University School of Medicine, Stanford, California.
  • 8 Department of Surgery, Emory School of Medicine.
  • 9 Department of Epidemiology, Rollins School of Public Health, and.
  • 10 Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia; and. , (Georgia)
Type
Published Article
Journal
Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Mar 01, 2020
Volume
31
Issue
3
Pages
625–636
Identifiers
DOI: 10.1681/ASN.2019030274
PMID: 31941721
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Despite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC). To 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. At 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. Female 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. Copyright © 2020 by the American Society of Nephrology.

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