Association of Race and Ethnicity with Initial Surgical Hemodialysis Access Type in a Safety Net System.

OBJECTIVES: Prior studies have found lower arteriovenous fistula (AVF) creation rates in Black and Hispanic patients. Whether this is due to health care disparities or other differences is unclear. Our objective was to evaluate the racial/ethnic differences in initial surgical access type within a high volume, safety net system with predominantly Black and Hispanic populations.

METHODS: A retrospective review of initial hemodialysis access in consecutive cases between 2014 and 2019 was conducted from all five safety net hospitals in a healthcare system that primarily treats underserved patients. Patient data collected included race, ethnicity, sex, co-morbidities, and initial AV access type (AVF vs. AV Graft (AVG). The rates of cephalic vein (CAVF)-based (radiocephalic, brachiocephalic) AVF were compared to basilic and brachial vein AVF (BAVF), as the latter are performed as two stages. Bivariate and multivariate logistic regression models were adjusted for demographic and clinical variables to evaluate the relationship between race/ethnicity, surgical access type, and comorbid conditions.

RESULTS: 1,334 patients (74% Hispanic, 9% Black, 7% Asian, 2% White, 8% Other) underwent first-time surgical hemodialysis access creation. The majority were male, 818 (63%). Medical comorbidities were equal among groups, except for COPD and stroke, which were higher in Black patients (p<0.005and p=0.005, respectively). Overall, 1303 (98%) underwent AVF creation and only 31 AVG (2%) with no difference between race/ethnicity in AVF vs. AVG creation. Of the AVF cohort, 991 (76%) had a CAVF, and 312 (24%) had a BAVF. Males were more likely than females to get a CAVF (65% vs. 35%, p= 0.002).

CONCLUSION: Within our safety net health system, where most patients are underrepresented minorities, nearly all patients undergoing hemodialysis access had an AVF as their initial surgery with no difference in race/ethnicity. AVF type received differed by race, with Black patients twice as likely to undergo BAVF, which required two stages. Further studies are needed to identify the reasons for these differences.