Related Experiment Video
Updated: Apr 13, 2026
08:39
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
2.2K
Racial/Ethnic Disparities Associated With Initial Hemodialysis Access
Devin S Zarkowsky1, Isibor J Arhuidese2, Caitlin W Hicks2
1Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
JAMA Surgery
|April 30, 2015
Summary
Black and Hispanic patients are less likely to initiate hemodialysis with an arteriovenous fistula (AVF) than white patients, even with fewer health issues. These disparities in AVF use persist regardless of insurance or care access, highlighting a need for further investigation.
Area of Science:
- Nephrology and Public Health
- Health Disparities Research
- Vascular Access for Hemodialysis
Background:
- Arteriovenous fistula (AVF) offers superior outcomes for initial hemodialysis.
- Racial and ethnic disparities in AVF utilization are not well understood.
- Factors like comorbidities, insurance, and specialist care may influence AVF access.
Purpose of the Study:
- To analyze national trends in initial hemodialysis access methods.
- To examine these trends across different racial/ethnic groups.
- To stratify analysis by comorbid disease, nephrology care, and insurance status.
Main Methods:
- Retrospective analysis of US Renal Data System (2006-2010).
- Compared utilization rates of AVF, arteriovenous graft, and catheter.
- Used logistic regression and propensity score-matching for racial/ethnic comparisons.
Main Results:
- White patients (18.3%) initiated hemodialysis with AVF more than Black (15.5%) or Hispanic (14.6%) patients.
- Black and Hispanic patients had lower AVF use despite younger age and fewer comorbidities.
- Disparities in AVF utilization persisted across insurance status and duration of nephrology care.
Conclusions:
- Significant racial/ethnic disparities exist in initial AVF utilization for hemodialysis.
- These disparities are independent of insurance and nephrology care access.
- Further investigation into sociocultural factors is needed to address these inequities.
Related Concept Videos
01:25Hemodialysis I: Introduction
3.6K
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
3.6K
01:24Hemodialysis II: Procedure and Complications
2.0K
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
2.0K
01:25Hemodialysis III: Nursing Management
1.7K
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
1.7K
01:27Dialysis
2.1K
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
2.1K
01:15Dialysis
2.3K
Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
2.3K
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
1.8K
Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
1.8K