Details

Autor(en) / Beteiligte

• Woo, Karen, MD
• Gascue, Laura, MA
• Goldman, Dana P., PhD
• Romley, John A., PhD

Titel

Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly

Ist Teil von

• Journal of vascular surgery, 2017-03, Vol.65 (3), p.783-792.e4

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Objective Prevalence of end-stage renal disease, modality of treatment, and type of hemodialysis vascular access used varies widely by race/ethnicity in the United States, but outcomes of hemodialysis vascular access by race/ethnicity are poorly described. The objective of this study is to evaluate variations in outcomes of hemodialysis vascular access in the elderly by race/ethnicity. Methods Medicare outpatient, inpatient, and carrier files were queried from 2006 to 2011 for beneficiaries that were age ≥66 years and dialysis-dependent at time of index fistula/graft creation, qualified for Medicare by age only, and were continuously enrolled in Medicare 12 months before and after index fistula/graft creation. Primary outcome measures were early vascular access failure and 12-month failure-free survival, specifically, the variation in the difference between fistula and graft in non-White vs White race/ethnicity groups. Results Fistulas comprised a smaller proportion of index procedures performed in Blacks (65.9%; P  < .001) and Asians (71.4%; P  < .001), compared with Whites (78.0%) with no difference in Hispanics (78.7%; P  = .59). Incidence of early failure after graft vs fistula was Whites, 34.9% vs 43.5% ( P  < .001), Blacks, 32.9% vs 49.1% ( P  < .001), Asians, 30.8% vs 40.5% ( P  = .014), and Hispanics 35.2% vs 43.2% ( P  = .005). The difference in early failure after fistula vs graft in Blacks was significantly larger than the difference in Whites ( P  < .001). The 12-month failure-free survival after index graft vs fistula was Whites 41.9% vs 38.9% ( P  = .008), Blacks 48.5% vs 37.3% ( P  < .001), Asians 51.6% vs 45.2% ( P  = .98), and Hispanics 51.9% vs 42.2% ( P  < .001). The difference in 12-month failure-free survival after graft vs fistula in Blacks and in Hispanics was larger than the difference in Whites ( P  < .001 and P  = .02, respectively). Conclusions Outcomes of fistulas vs grafts in the elderly vary significantly by race/ethnicity. The decreased risk of early failure after graft vs fistula creation is larger in Blacks compared with Whites. The higher failure-free survival at 12 months after graft vs fistula creation is larger in Blacks compared with Whites and trends toward being larger in Hispanics compared with Whites.