Abstract: TH-OR03
Impact of Predialysis Nephrology Care on Incident Vascular Access Outcome among Hispanic Individuals: A Causal Mediation Analysis
Session Information
- Achieving More Equitable Kidney Care
October 24, 2024 | Location: Room 7, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Scheiffele, Grant D., US Department of Veterans Affairs, Gainesville, Florida, United States
- Guo, Serena Jingchuan, University of Florida, Gainesville, Florida, United States
- Huang, Wenxi Huang, University of Florida, Gainesville, Florida, United States
- Guo, Yi, University of Florida, Gainesville, Florida, United States
- Shukla, Ashutosh M., US Department of Veterans Affairs, Gainesville, Florida, United States
Background
Predialysis care is a dominant predictor of incident vascular access outcomes. Prior studies have shown significant disparities in predialysis nephrology care among Hispanic patients with ESKD, compared to non-Hispanic Whites; however, its relative contributions to disparities in vascular access outcomes is unknown.
Methods
Analyzing patients initiating hemodialysis between 2009 and 2019 in URSDS, we examined the impact of disparities in predialysis nephrology care on incident vascular access use among Hispanic individuals, compared to non-Hispanic White individuals. Adjusting for critical patient-level variables, we conducted series of logistic regression and causal mediation analyses to dissect the attributable influence of disparities in predialysis nephrology care on vascular access use.
Results
Among the 427,340 adult Medicare recipients initiating their first-ever hemodialysis between 2010-2019; 269,697 Non-Hispanic White and 46,146 Hispanic individuals, 276,652 initiated with pure central venous catheter (CVC) without any maturing Arteriovenous Fistula (AVF) or Arteriovenous Graft (AVG) and 75,238 initiated with AVF or AVG. After adjusting for patient-level variables, compared to Non-Hispanic Whites, odds of predialysis nephrology care were 64% (95%CI: 63–66%) and odds of incident AVF/AVG use were 71% (95%CI:69-74%) amongst patients with Hispanic ethnicity. Causal mediation analysis showed that 33% (95%CI:29-37%) of the incident vascular access underuse was attributable to the disparities in predialysis renal care. Sensitivity analyses examining stronger mediators in form of more than 6-month nephrology care and predialysis kidney disease education showed even stronger mediating influence on vascular access outcomes (Table 1).
Conclusion
Disparities in predialysis nephrology care mediate nearly a third of disparities in vascular access outcomes among Hispanic ESKD population. Efforts are needed to universalize predialysis nephrology care and kidney disease education services for all Hispanic individuals at high risk of kidney failure.
Funding
- Veterans Affairs Support