Black patients more likely to experience dialysis graft failure, costly repercussions

Black patients are more likely to experience a failure of their dialysis graft and the costly ramifications that come with it, according to an analysis published Tuesday in Radiology [1].

Providers typically place these flexible tubes to create a path between the artery and vein to facilitate dialysis. Arteriovenous grafts, in particular, are used for those with smaller or weaker blood vessels. Failure of the graft can result in interventional radiologists having to perform a maintenance procedure. And repeat procedures within 30 days can lead to death, along with increased costs and burden for both patients and the healthcare system.

Experts recently sought to better understand how this phenomenon impacts black patients, in particular. Previous studies have found race—along with female sex, older age, comorbidities such as diabetes, and smoking history—to be a factor associated with premature access failure. Findings from the analysis, which used Veterans Health Administration data, demonstrate a clear opportunity to address health inequities.

“African American patients are more vulnerable to experiencing early dialysis access dysfunction and failure when compared to their other racial counterparts,” Mikhail C.S.S. Higgins, MD, assistant professor from the Department of Radiology at Boston University Chobanian and Avedisian School of Medicine, said in a statement. “This relative predisposition to this complication represents a disparity in care and adverse outcomes in a largely understudied population, namely the VHA system.”

The study utilized data representing all hemodialysis vascular maintenance procedures performed between October 2016 and March 2020. Higgins et al. pinpointed a total of 1,950 AV graft procedures performed on 995 patients at 61 Veterans Health Administration facilities. Interventional radiologists handled the lion’s share of such cases, with most involving black patients (60%) and having been delivered in the southern region of the U.S. (51%).

Grafts failed prematurely in about 11% of procedures, with race an associated factor (after adjusting for factors such as comorbidities). Half of the 61 facilities in the study had an interventional radiology resident training program, and those sites produced lower rates of graft failure including no evidence of disparities across 1,057 procedures. However, further studies are needed to better understand this finding, the authors cautioned.

“We cannot say that patients should find hospitals with teaching programs, as our results do not show this direct relationship," co-author Hillary J. Mull, PhD, an investigator for the Center for Healthcare Organization and Implementation Research for the VA Boston Healthcare System in Massachusetts, said in the statement. “Rather, teaching is associated with equitable patient outcomes for dialysis access maintenance procedures and there are likely unmeasured factors associated with teaching programs that influence this relationship.”