Annals of vascular surgery · 2026
Association of Race and Socioeconomic Status with Hemodialysis Arteriovenous Access Outcomes.
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Ranjbar Keivan, Jang Jeongin, Rodrigues Rahul, Bulusu Gautam, Atiq Muhammad, Palvannan Prashanth, Kumar Shivani, Siracuse Jeffrey, Salehi Payam
Аннотация
OBJECTIVES: Arteriovenous access is essential for long-term hemodialysis. The creation and maintenance of arteriovenous fistula (AVF) or arteriovenous graft (AVG) are critical for effective dialysis and minimizing complications. However, the influence of race and social determinants of health on presentation, management, and outcomes has not been well evaluated. This study uses the Vascular Quality Initiative (VQI) database to evaluate disparities in vascular access outcomes by race and community-level disadvantage.
METHODS: We conducted a retrospective study using the VQI database to identify adults who underwent AVF or AVG creation for hemodialysis between 2016 and 2023. The Area Deprivation Index (ADI), a validated measure of neighborhood socioeconomic disadvantage incorporating income, education, employment, and housing quality, was categorized into quartiles from least (Q1) to most disadvantaged (Q4). Patients without follow-up data, recorded complications, or ADI information were excluded. Predisposing factors and postoperative outcomes considering race and ADI were analyzed. Group comparisons were performed using chi-square tests and t-tests. Multivariable logistic regression adjusted for demographic and clinical covariates was used to assess associations. All analyses were conducted using SPSS version 30.
RESULTS: A total of 77,544 patients were included (mean age 62.2 years, 43.4% female). White patients represented the largest racial group (51.5%, n=39,959), and 29.5% (n=22,850) were from the most disadvantaged ADI quartile. AVF maturation was more delayed in White vs Black patients (adjusted OR 1.43, 95% CI: 1.21-1.70, p<0.001). Immediate postoperative bleeding was less common in White vs Black patients (0.6% vs 0.9%; OR 0.58,0.43-0.79, p<0.001) and less frequent in Q4 vs Q1 (0.5% vs 1.2%; OR 0.36, 0.25-0.53, p<0.001). At 9 months, access patency was lower in Black vs White patients (86.4% vs 88.2%, p=0.003) and varied by ADI (p<0.001), with Q1 achieving the highest patency (88.7%). Nine-month mortality was highest in White patients (28% vs 21% in Black, p<0.001 unadjusted); however, only Asian race remained independently protective after adjustment (OR 0.41, 0.35-0.47, p<0.001 vs Black). Patients in Q4 had significantly higher 9-month mortality compared to Q1 (adjusted OR 1.56, 1.46-1.67, p<0.001).
CONCLUSIONS: Significant disparities in hemodialysis access outcomes exist by race and socioeconomic status. Patients in disadvantaged areas experienced higher rates of maturation delay and mortality. Black and American Indian/Alaskan Native patients had worse patency and greater AVG use. Structural and social factors strongly influence vascular access outcomes, underscoring the need for targeted interventions to improve equity in hemodialysis care.
METHODS: We conducted a retrospective study using the VQI database to identify adults who underwent AVF or AVG creation for hemodialysis between 2016 and 2023. The Area Deprivation Index (ADI), a validated measure of neighborhood socioeconomic disadvantage incorporating income, education, employment, and housing quality, was categorized into quartiles from least (Q1) to most disadvantaged (Q4). Patients without follow-up data, recorded complications, or ADI information were excluded. Predisposing factors and postoperative outcomes considering race and ADI were analyzed. Group comparisons were performed using chi-square tests and t-tests. Multivariable logistic regression adjusted for demographic and clinical covariates was used to assess associations. All analyses were conducted using SPSS version 30.
RESULTS: A total of 77,544 patients were included (mean age 62.2 years, 43.4% female). White patients represented the largest racial group (51.5%, n=39,959), and 29.5% (n=22,850) were from the most disadvantaged ADI quartile. AVF maturation was more delayed in White vs Black patients (adjusted OR 1.43, 95% CI: 1.21-1.70, p<0.001). Immediate postoperative bleeding was less common in White vs Black patients (0.6% vs 0.9%; OR 0.58,0.43-0.79, p<0.001) and less frequent in Q4 vs Q1 (0.5% vs 1.2%; OR 0.36, 0.25-0.53, p<0.001). At 9 months, access patency was lower in Black vs White patients (86.4% vs 88.2%, p=0.003) and varied by ADI (p<0.001), with Q1 achieving the highest patency (88.7%). Nine-month mortality was highest in White patients (28% vs 21% in Black, p<0.001 unadjusted); however, only Asian race remained independently protective after adjustment (OR 0.41, 0.35-0.47, p<0.001 vs Black). Patients in Q4 had significantly higher 9-month mortality compared to Q1 (adjusted OR 1.56, 1.46-1.67, p<0.001).
CONCLUSIONS: Significant disparities in hemodialysis access outcomes exist by race and socioeconomic status. Patients in disadvantaged areas experienced higher rates of maturation delay and mortality. Black and American Indian/Alaskan Native patients had worse patency and greater AVG use. Structural and social factors strongly influence vascular access outcomes, underscoring the need for targeted interventions to improve equity in hemodialysis care.