Race and Sex Disparities in Outcomes of Dialysis Access Maintenance Interventions

Purpose: To determine whether utilization and outcomes of dialysis access maintenance interventions vary by patient race or sex. Materials and Methods: Data for this retrospective cohort study of first-time arteriovenous (AV) access recipients were drawn from a 5% sample of Medicare beneficiaries, containing claims from all clinical settings (2009–2014) in 2,693 patients who received their first AV fistula/graft in 2009. Maintenance interventions—angiography, angioplasty, thrombolysis, stent placement, and venous embolization—were identified by corresponding Current Procedural Terminology codes. Outcomes of primary patency (PP), postinterventional primary patency (PIPP), and postinterventional secondary patency (PISP) were calculated with utilization records. Associations between demographic data and patency times were evaluated by a multivariate survival approach, controlling for baseline differences in patient age, comorbid disease, type of dialysis access, and interventionist specialty. Results: AV grafts (AVGs) were created with greater frequency in women (32% vs 23% in men; P <.001) and minority patients (39% in black, 32% in Hispanic, and 29% in Asian patients vs 21% in white patients; P <.001). Women were at greater hazards for loss of PP (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.09–2.14) and PIPP (HR, 1.42; 95% CI, 1.01–2.00). Black patients were at greater hazards for loss of PP (HR, 1.37; 95% CI, 1.23–1.54) and PISP (HR, 1.29; 95% CI, 1.01–1.65). AVG creation predisposed patients to patency loss in all models (P <.001). Conclusions: Dialysis access patency rates are lower for women and black patients. More frequent primary AVG creation in women and minority patients additionally predisposes these patients to patency loss.