The authors behind a new study that found “significant differences” in hemodialysis vascular access outcomes after first-time arteriovenous (AV) fistula or graft creation “directly related” to a patient’s race said the findings speak “to an injustice within the field of vascular surgery.” The research won the Midwestern Vascular Surgical Society’s inaugural MVSS Disparities Research Award at the organization’s 2022 annual meeting in Grand Rapids, Michigan (Sept. 15–17).
The data were presented by Shannon McDonnell, a medical student from Loyola University’s Stritch School of Medicine in Maywood, Illinois, who was mentored by Pegge Halandras, MD, from Loyola University Medical Center.
The research team carried out a single-institution, retrospective cohort study of 926 patients undergoing AV procedures from 2007 to 2021, capturing subsequent AV creations and maintenance procedures. Of the total pool, 45% identified as White and 37% as Black, McDonnell reported. A total of 494 (53%) patients had no additional procedures, 258 (28%) had one additional procedure, 95 (10%) had two additional procedures, and 78 (9%) had three or more procedures.
“Black patients have higher frequency of hypertension, COPD [chronic obstructive pulmonary disease], diabetes and anemia,” McDonnell told MVSS 2022. “Just over half of our patients required only the initial fistula or graft placement. Black patients were at a significantly higher risk of having additional AV access surgical procedures, including both maintenance and new creations as compared to their counterparts of other races. Further exploration of these disparities is necessary in order to discover the root of these inequities in care.”
In acknowledging limitations in the study, McDonnell pointed to race’s frequent association with lower socioeconomic status. “Lower socioeconomic status influences a patient’s utilization of healthcare and can lead to poorer outcomes, and worse-managed chronic conditions,” she said.
McDonnell also pointed to some reasons why patients may only have one procedure at the study team’s institution, such as a patient receiving a kidney transplant or choosing to continue to dialyze through a catheter instead of undergoing another procedure.