CLINICAL QUESTION: Is there a relationship between access to pre-dialysis nephrology care and the presence of usable arteriovenous (AV) access at dialysis initiation among Hispanic individuals?
BACKGROUND: Hemodialysis via AV vascular access is associated with reduced complications and costs compared to central venous catheter (CVC) access. However, rates of AV access remain low at dialysis initiation, particularly in the Hispanic population. Prior studies have demonstrated an association between pre-dialysis nephrology care and the presence of a mature AV fistula at dialysis initiation, but the magnitude of this association had not been previously quantified or explored in Hispanic patients.
STUDY DESIGN: Retrospective cohort study
SETTING: The U.S. Renal Data System, a nationwide database, was queried for adult Medicare recipients starting hemodialysis between 2010 and 2019, with primary analysis restricted to those who had at least six months of Medicare status before dialysis initiation, and excluding those who received prior transplants.
SYNOPSIS: Of 427,340 patients identified by the database search, 46,146 patients self-identified as Hispanic and 269,697 as white; the remainder were non-Hispanic Black or other races and ethnicities. Compared to white patients, Hispanic patients were less likely both to have received pre-dialysis nephrology care (adjusted odds ratio [aOR], 0.70; 95% CI, 0.68 to 0.72) and to have mature AV access (aOR, 0.77; 95% CI, 0.75 to 0.80) at dialysis initiation. Lack of pre-dialysis nephrology care was associated with 32.59% (P <0.001) of this disparity by statistical analysis. Additionally, Hispanic patients have significantly higher odds of conversion from CVC to AV access in the first year of dialysis (30% CVC only, 38% CVC with maturing AV access), when all patients are under nephrology care. Study limitations include separating self-reported ethnicity and race into only Hispanic, Black, white, and other; limited ability to explore residual associations driving disparities related to study design; and inability to assess other patient-specific factors like language or social determinants of health. Nonetheless, applications to hospital systems serving Hispanic patient populations are clear, and such systems should prioritize policy and practice measures aimed at enhancing access to pre-dialysis care for these patients.
BOTTOM LINE: Hispanic patients have lower rates of pre-dialysis nephrology care, and by association, lower rates of usable AV dialysis access at the time of dialysis initiation compared to white patients.
CITATION: Pramod S, et al. Predialysis nephrology care disparities and incident vascular access among Hispanic individuals. JAMA Netw Open. 2025;8(9):e2530972. doi: 10.1001/jamanetworkopen.2025.30972.
Dr. Burgoon is a hospitalist and instructor in medicine at Columbia University Irving Medical Center in New York.