Disparities in arteriovenous fistula placement in older hemodialysis patients
Disparities in arteriovenous fistula placement in older hemodialysis patients
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DOI：
10.1111/hdi.12099
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发表时间：
2014-01-01
影响因子：
1.3
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
中科院分区：
文献类型：
--
作者：
Patibandla, Bhanu K.;Narra, Akshita;Goldfarb-Rumyantzev, Alexander S.
动静脉内瘘（AVF）作为血液透析首选血管通路的受益已得到明确证明。然而，在美国只有大约20%的患者开始使用AVF进行血液透析。在本研究中，我们评估了透析开始前放置的首次血液透析通路类型（而不是透析开始时使用的）是否存在差异，以检测某些弱势群体是否可能具有AVF放置的可能性较低。将来自美国肾脏数据系统的118，767例年龄≥ 67岁（1/2005-12/2008）的血液透析患者的研究队列与Medicare索赔数据相关联，以确定透析前放置的初始通路类型。我们使用逻辑回归模型，结果是AVF的初始透析前放置，而不是动静脉移植物或中心静脉导管。年龄增加、女性、黑人、较低的体重指数、城市位置、某些合并症和较短的终末期肾病前肾病治疗都与AVF放置作为初始通路透析前的可能性显著降低相关。我们的研究表明，AVF作为初始血液透析血管通路的放置存在显著差异。我们建议应额外关注这些患者群体，通过患者教育、早期转诊和密切随访来改善差异。
The benefits of an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis have been clearly demonstrated. However, only about 20% of patients in the United States initiate hemodialysis with an AVF. In this study, we assessed whether disparities exist in the type of first hemodialysis access placed prior to dialysis start (rather than that used at dialysis initiation), to detect whether certain disadvantaged groups might have lower likelihood of AVF placement. Study cohort of 118,767 incident hemodialysis patients >= 67 years of age (1/2005-12/2008) derived from the United States Renal Data System was linked with Medicare claims data to identify the type of initial access placed predialysis. We used logistic regression model with outcome being the initial predialysis placement of an AVF as opposed to an arteriovenous graft or a central venous catheter. Increasing age, female sex, black race, lower body mass index, urban location, certain comorbidities, and shorter pre-end-stage renal disease nephrology care are all associated with a significantly lower likelihood of AVF placement as initial access predialysis. Our study suggests the presence of significant disparities in the placement of an AVF as initial hemodialysis vascular access. We suggest that additional attention should be paid to these patient groups to improve disparities by patient education, earlier referral, and close follow-up.