Hispanic ethnicity and vascular access use in patients initiating hemodialysis in the United States

Cristina M. Arce, Aya A. Mitani, Benjamin A. Goldstein, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background and objectives Hispanics are the largest minority in the United States (comprising 16.3% of the US population) and have 1.5 times the age-, sex-, and race-adjusted incidence of ESRD compared with non-Hispanics. Poor health care access and low-quality care generally received by Hispanics are well documented. However, little is known regarding dialysis preparation of Hispanic patients with progressive CKD. Design, setting, participants, & measurements Using data from Medical Evidence Report form CMS-2728-U3, 321,996 adult patients of white or black race were identified who initiated hemo dialysis (HD)between July 1, 2005 and December 31, 2008. The form captures Hispanic ethnicity, vascular access use at first outpatient HD, sociodemographic characteristics, and comorbidities. This study also examined whether use of an arteriovenous fistula (AVF) or graft (AVG) was reported. Results AVF/AVG use was reported in 14.5% of Hispanics and 17.6% in non-Hispanics (P<0.001). The unadjusted prevalence ratio (PR) was 0.85 (95% confidence interval [95% CI], 0.83-0.88), indicating that Hispanics were 15% less likely to use AVG/AVF for their first outpatient HD. Adjustment for age, sex, and race, as well as a large number of comorbidities and frailty indicators, did not change this association (PR, 0.85; 95% CI, 0.83-0.88). Further adjustment for timing of first predialysis nephrology care, however, attenuated the PR by two-thirds (PR, 0.94; 95% CI, 0.92-0.97). Conclusions Hispanics are less likely to use arteriovenous access for first outpatient HD compared with non-Hispanics, which seems to be explained by variation in the access to predialysis nephrology care.

Original languageEnglish (US)
Pages (from-to)289-296
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number2
DOIs
StatePublished - Feb 1 2012

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Hispanic Americans
Blood Vessels
Renal Dialysis
Dialysis
Arteriovenous Fistula
Outpatients
Nephrology
Confidence Intervals
Transplants
Comorbidity
Quality of Health Care
Chronic Kidney Failure
Delivery of Health Care
Incidence
Population

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Hispanic ethnicity and vascular access use in patients initiating hemodialysis in the United States. / Arce, Cristina M.; Mitani, Aya A.; Goldstein, Benjamin A.; Winkelmayer, Wolfgang C.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 2, 01.02.2012, p. 289-296.

Research output: Contribution to journalArticle

Arce, Cristina M. ; Mitani, Aya A. ; Goldstein, Benjamin A. ; Winkelmayer, Wolfgang C. / Hispanic ethnicity and vascular access use in patients initiating hemodialysis in the United States. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 2. pp. 289-296.
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abstract = "Background and objectives Hispanics are the largest minority in the United States (comprising 16.3{\%} of the US population) and have 1.5 times the age-, sex-, and race-adjusted incidence of ESRD compared with non-Hispanics. Poor health care access and low-quality care generally received by Hispanics are well documented. However, little is known regarding dialysis preparation of Hispanic patients with progressive CKD. Design, setting, participants, & measurements Using data from Medical Evidence Report form CMS-2728-U3, 321,996 adult patients of white or black race were identified who initiated hemo dialysis (HD)between July 1, 2005 and December 31, 2008. The form captures Hispanic ethnicity, vascular access use at first outpatient HD, sociodemographic characteristics, and comorbidities. This study also examined whether use of an arteriovenous fistula (AVF) or graft (AVG) was reported. Results AVF/AVG use was reported in 14.5{\%} of Hispanics and 17.6{\%} in non-Hispanics (P<0.001). The unadjusted prevalence ratio (PR) was 0.85 (95{\%} confidence interval [95{\%} CI], 0.83-0.88), indicating that Hispanics were 15{\%} less likely to use AVG/AVF for their first outpatient HD. Adjustment for age, sex, and race, as well as a large number of comorbidities and frailty indicators, did not change this association (PR, 0.85; 95{\%} CI, 0.83-0.88). Further adjustment for timing of first predialysis nephrology care, however, attenuated the PR by two-thirds (PR, 0.94; 95{\%} CI, 0.92-0.97). Conclusions Hispanics are less likely to use arteriovenous access for first outpatient HD compared with non-Hispanics, which seems to be explained by variation in the access to predialysis nephrology care.",
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