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By a News Reporter-Staff News Editor at VerticalNews Health -- Black and Hispanic patients will less frequently than white patients start hemodialysis with an arteriovenous fistula (connecting an artery to a vein for vascular access), a procedure for initial blood flow access known to result in superior outcomes compared with either catheters or arteriovenous grafts, according to a report published online by JAMA Surgery.
End-stage kidney disease affected more than 593,000 people in the United States in 2010 and more than 383,000 of them were treated with hemodialysis, a process that replaces the blood filtering usually done by the kidneys, according to background in the information in the study.
Mahmoud B. Malas, M.D., M.H.S., of the Johns Hopkins Medical Institutions, Baltimore, and coauthors examined national trends in initial hemodialysis access with respect to race/ethnicity further divided by co-existing illnesses, nephrology care and medical insurance status.
Their study was a retrospective analysis of 396,075 patients with end-stage renal disease in the U.S. Renal Data System who started dialysis from 2006 through 2010. The main outcomes of the study were utilization rates of arteriovenous fistula (AVF), arteriovenous graft (AVG) and intravascular hemodialysis catheter (IHC). Most of the patients (55.4 percent) in the study were white, followed by 30.3 percent black patients and 14.3 percent Hispanic patients.
The authors found that more white patients initiated hemodialysis with an AVF than black or Hispanic patients (18.3 percent vs. 15.5 percent and 14.6 percent, respectively), although black and Hispanic patients tended to be younger and had less coronary artery disease, chronic obstructive pulmonary disease and cancer than white patients with an AVF. Regardless of medical insurance status, both black and Hispanic patients started hemodialysis with an AVF less frequently than white patients. AVF utilization at initial hemodialysis also was lower among black patients and Hispanic patients compared with white patients among patients who had nephrology care for longer than one year.
The authors note it is possible black and Hispanic patients with chronic kidney disease may be progressing too quickly to end-stage renal disease to make AVFs a viable initial hemodialysis access option because AVFs generally take six to 12 weeks to mature and grow stronger.
"The racial/ethnic disparities in incident AVF access that we describe deserve elucidation. The high rates of catheter use despite national programs to reverse this trend is unacceptable. ... The sociocultural underpinnings of these disparities deserve investigation and redress to maximize the benefits of initiating hemodialysis via fistula in patients with ESRD [end-stage renal disease] irrespective of race/ethnicity," the study concludes.
(JAMA Surgery. Published online April 29, 2015. doi:10.1001/jamasurg.2014.0287. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
In a related commentary, Laura A. Peterson, M.D., M.S., and Matthew A. Corriere, M.D., M.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., write: "Their analysis of the U.S. Renal Data System contributes useful insight into racial/ethnic differences in arteriovenous fistula (AVF) utilization, accounting for patient comorbidities, insurance status and health care provider specialty, but the overall rates of AVF use (or more appropriately the lack of AVF use) at first hemodialysis are perhaps the more important and concerning finding. Rates of AVF use at hemodialysis initiation were 18.3 percent, 15.5 percent and 14.6 percent among white, black and Hispanic patients, respectively. These results are especially sobering compared with the 2006 goals from the National Kidney Foundation, including prevalent functional AVF in more than 65 percent of patients and cuffed catheters in less than 10 percent. ... Given the mismatch between goals and current outcomes, the more appropriate quality improvement focus may be lowering the dismal overall catheter rates instead of a less than 5 percent difference in AVF rates between races/ethnicities."
(JAMA Surgery. Published online April 29, 2015. doi:10.1001/jamasurg.2015.0321. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory: To contact corresponding author Mahmoud B. Malas, M.D., call Ekaterina Pesheva at 410-502-9433 or email
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or call Karen Tong at 410-550-0128 or email
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. To contact commentary author Matthew A. Corriere, M.D., call Marguerite Beck at 336-716-2415 or email
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.
To place an electronic embedded link to this study in your story: Links will be live at the embargo time: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2014.0287 and http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2015.0321
Keywords for this news article include: Kidney, Surgery, Angiology, Nephrology, Hemodialysis, Renal Disease, Renal Dialysis, Health Insurance, Investment and Finance, The JAMA Network Journals.
Our reports deliver fact-based news of research and discoveries from around the world. Copyright 2015, NewsRx LLC
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ROBYN EDIE/FAIRFAX NZ Invercargill man Bill Veth hooking up to his own dialysis machine at home. After living out of a motel in Dunedin for a year, Invercargill man Bill Veth says there is nothing more luxurious than putting his feet up back at his own home.About eight years ago 68-year-old Veth started suffering from kidney failure, which left him dependant on dialysis.Since his diagnosis, he has tried many different methods of dialysis, including one that had him hooked up to for ten hours every night. All while working fulltime."I hooked it up at 8pm at the latest because I had to be up at six, it didn't suit me."Veth spent a year living part-time in Dunedin having five hours of dialysis, three days a week."I didn't know anybody in Dunedin except for the nurses," he said.Dialysis is the clinical purification of blood, which works as a substitute for the normal function of the kidney.His life has changed for the better since getting a hemodialysis machine installed in his house. Spending 15 hours a week hooked up to dialysis was not straightforward, but having the machine at home was a big comfort, he said.He watches television, keeps a thermos of coffee beside him and has the control for the heat pump if he gets too cold. The system suits him, but the time did drag on, he said,"You get a bit tired of it. The last hour seems to take three times as long, it seems forever." Veth has an entire room at his house dedicated to his medical supplies, which he orders once a month.Royal District Nursing Service (RDNS) support worker Leanne Nieborg-Reid visits Veth three times a week to assist with his dialysis. Having a machine at home made a world of difference to Veth, she said.Veth moved to New Zealand from the Netherlands in 1966 and after living in Canterbury, moved to Southland in the late 1970s. He worked as a commercial painter before he retired in December 2012.Only four months later, with very little warning, Veth's wife died suddenly of lung cancer."She came home from work and couldn't see out of one eye, she went to the doctor the next day and she passed away a few weeks later."I never expected it to happen so quick but I'm glad that she didn't suffer."Before moving to New Zealand, Veth worked in the Netherlands merchant navy and still misses life on the ships. Despite living an active life until recent years, he was now just grateful for what he could do. He cannot travel far, because he needs to be back in Southland for dialysis, but his in-home care represents freedom for him. It gives him opportunities, like a weekend trip to Dunedin with his friends to watch the rugby and have dinner out.RDNS media and communications specialist John Allin said organisations such as RDNS have to remain nimble in the changing face of the health system."There are three big problems the health system faces, one is that people are living longer and also they are living longer with chronic disease."Governments all over the world are grappling with the challenge of making sure their aging populations are looked after."It was because of these problems that it was so important that people like Veth could stay at home in familiar surroundings, he said. - The Southland Times Next News story:
