Abstract: TH-PO259
Patient Perspectives on Arteriovenous Fistula Use: Implications for Racial Disparities
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Patel, Dipal, Johns Hopkins University, Baltimore, Maryland, United States
- Lee, Timmy C., The University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, United States
- Zhang, Yi, The University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, United States
- Thamer, Mae, Medical Technology and Practice Patterns Institute, Bethesda, Maryland, United States
- Allon, Michael, The University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, United States
- Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States
Background
Placement and maintenance of arteriovenous fistulas (AVFs) are a key quality metric in the care of patients on hemodialysis (HD). Compared to White patients, Black patients are less likely to undergo AVF placement, experience successful AVF use, and maintain AVF patency. We examined factors influencing AVF use in a group of predominantly Black patients receiving HD.
Methods
Semi-structured individual interviews were conducted via telephone or teleconference with 59 patients receiving HD at one of eleven facilities affiliated with an academic nephrology practice in the Southern U.S. Interviews were audiorecorded and transcripts were coded for thematic analysis.
Results
Transcripts from 53 Black and 6 White patients were used for analysis [Table 1]. Common themes influencing patient perspectives on AVF use centered around the circumstances of dialysis initiation, pre-dialysis and ongoing patient education, and comparisons of different access types including their impact on patients’ lives [Figure 1]. The following experiences were highlighted: 1) the vast majority of patients experienced “crash” dialysis starts through a CVC, even when receiving pre-dialysis care, 2) patients who voiced trust of their medical care teams reported a higher level of comfort with AVF placement, 3) pre-AVF patients had a poor understanding of the steps of a fistula procedure and post-surgical care, and 4) when comparing access types, patients most commonly reported CVCs to be troublesome due to showering restrictions and infection concerns, whereas fistulas carried higher risks of pain, bleeding, and altering patient appearance.
Conclusion
Patient perspectives on AVF placement, use, and maintenance may inform our understanding of racial disparities in the AVF care continuum.
| Patient Demographics | Pre-AVF (n=15) | Maturing AVF (n=8) | Failed AVF (n=5) | AVF in Use (n=31) | Total (n=59) |
| Age in years [average (range)] | 48 (29, 66) | 52 (26, 75) | 58 (49, 68) | 53 (20, 83) | 52 (20, 83) |
| Race (B=Black, W=White) | 12B, 3W | 7B, 1W | 4B, 1W | 30B, 1W | 53B, 6W |
| Gender (M=Male, F=Female) | 9M, 6F | 6M, 2F | 2M, 3F | 18M, 13F | 35M, 24F |
| Dialysis vintage in days [average (range)]* | 715 (32, 2715) | 783 (48, 4400) | 2721 (489, 3844) | 1448 (51, 4361) | 1263 (32, 4400) |
*Dialysis vintage data is for 52 of the 59 patients
Funding
- Other NIH Support