TOPLINE:

Hispanic patients initiating hemodialysis in the US were less likely to receive predialysis nephrology care and had lower rates of usable vascular access at dialysis initiation than White patients. System-based disparities in predialysis nephrology care accounted for about one third of the incident vascular access gap among Hispanic patients.

METHODOLOGY:

• Although predialysis nephrology care is known to improve the likelihood of starting hemodialysis with a mature, usable arteriovenous access, its role in driving racial and ethnic disparities in vascular access remains unclear.
• Researchers conducted a retrospective analysis to quantify the impact of lacking predialysis nephrology care on incident vascular access outcomes in Hispanic patients.
• They included 427,340 adult Medicare recipients who initiated hemodialysis between 2010 and 2019 and had at least 6 months of predialysis Medicare coverage; 21.7% were Black, 10.8% were Hispanic, and 63.1% were White individuals.
• The analysis focused on self-reported race and ethnicity, with non-Hispanic White ethnicity serving as the reference and Hispanic ethnicity being the primary comparator; predialysis nephrology care served as the primary mediator.
• The primary outcome was the attributable association between predialysis nephrology care and incident vascular access disparity.

TAKEAWAY:

• Hispanic patients had 30% lower odds of receiving predialysis nephrology care than White patients (odds ratio [OR], 0.70; 95% CI, 0.68-0.72).
• At dialysis initiation, 14.5% of patients had an arteriovenous fistula, 3.1% had a graft, and 82.2% had a central venous catheter; Hispanic patients had 23% lower odds of starting with usable vascular access than White patients (OR, 0.77; 95% CI, 0.75-0.80).
• The lack of predialysis nephrology care accounted for 32.59% of incident vascular access underuse and 62% of maturing vascular access underuse among Hispanic patients; its contribution became more prominent when a longer duration of predialysis nephrology care was considered.
• Among patients starting with a central venous catheter, Hispanic patients were more likely than White patients to transition to a functional arteriovenous fistula or graft within the first year of dialysis, suggesting that many began treatment with a catheter due to insufficient predialysis care.

IN PRACTICE:

“Despite being younger and having lower comorbidity burden, Hispanic patients had 23% lower rates of usable incident hemodialysis vascular access compared with White patients, and approximately 33% of this disparity is attributable to Hispanic patients’ lack of access to nephology care in the predialysis period,” experts noted in an invited commentary.

“Although some disparities are linked to differences in predialysis care, many result from both individual and systemic factors that disproportionately affect minoritized Hispanic communities,” they added.

SOURCE:

The study was led by Sheena Pramod, MD, Division of Nephrology, Hypertension, and Transplantation, Department of Medicine, University of Florida in Gainesville, Florida. It was published online on in JAMA Network Open.

LIMITATIONS:

Although limited access to care explained much of the vascular access gap for Hispanic patients, a substantial unexplained disparity remained, likely driven by complex practitioner- and patient-level factors. The analysis was only restricted to Medicare beneficiaries.

DISCLOSURES:

One author received research support from the US Department of Veterans Affairs, Health Service Research and Development, Office of Rural Health, and Clinical Science Research and Development. The same author also disclosed having a consultancy agreement with Chemocentryx, Inc., and serving in an advisory role for the Veterans Health Administration Home Dialysis Committee.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.