Abstract
BACKGROUND: Arteriovenous fistula (AVF) use is reported to differ among racial and gender groups. We sought to identify risk factors associated with incident AVF and whether racial and gender differences in AVF use persist after controlling for these factors. METHODS: We evaluated 28,712 incident adult hemodialysis patients (age ≥ 18) from five ESRD networks starting dialysis between June 1, 2005 and May 31, 2006. Data were obtained from the Center for Medicaid and Medicare Services 2728 form. RESULTS: Incident AVF use was reported for 11% of black and 12% of white patients [OR = 0.89 (95% CI: 0.83, 0.96)], and for 9% of females and 13% of males [OR = 0.66 (0.62-0.71)]. After adjusting for facility clustering, blacks were as likely as whites to use an AVF [OR = 1.00 (0.92-1.09)], while gender differences persisted [OR = 0.64 (0.59-0.69)]. Compared to patients with no renal care prior to dialysis initiation, incident AVF use was 16-fold greater among those with ≥ 12 months of nephrology care [OR = 15.99 (13.25-19.29)], 9-fold greater among those with 6-12 months of care [OR = 9.00 (7.45-10.88)] and 7-fold greater among those with at least 6 months of care [OR = 7.13 (5.73-8.88)]. CONCLUSION: Racial, but not gender, differences in incident AVF use were eliminated after accounting for clustering within facilities.