Disparities in Predialysis Nephrology Care Affect Vascular Access for Hispanic Patients

Recent research highlights significant disparities in access to predialysis nephrology care that negatively impact vascular access outcomes for Hispanic patients undergoing hemodialysis. A study published in JAMA Network Open assessed data from the 2021 U.S. Renal Database System, revealing that systemic differences in healthcare access were linked to lower rates of mature and usable arteriovenous access among this demographic.

The analysis included 427,340 patients who started hemodialysis, comprising 21.7% Black, 10.8% Hispanic, 63.1% White, and 4.35% from other racial and ethnic backgrounds. The findings showed that only 14.5% of patients received arteriovenous fistulas (AVFs), 3.1% used arteriovenous grafts (AVGs), and a staggering 82.2% relied on central venous catheters (CVCs) for vascular access.

Adjusted odds ratios indicated that Hispanic patients were less likely to receive predialysis nephrology care compared to their White counterparts, with odds ratios of 0.70 for care access and 0.77 for incident vascular access. The study concluded that the absence of nephrology care was responsible for 32.59% of the disparities in incident vascular access and an alarming 62.00% of the underutilization of mature vascular access.

Moreover, the research revealed that Hispanic patients with CVCs, along with those possessing maturing AVFs or AVGs, had higher probabilities of transitioning to functional AVFs or AVGs within their first year of dialysis when compared to White patients. The respective odds ratios for these transitions were 1.38 and 1.30, although these outcomes were adversely affected by the lack of predialysis care.

The authors emphasize the importance of conducting further mechanistic studies to better understand the underlying factors influencing kidney failure outcomes, particularly among populations facing healthcare access disparities.