(Press-News.org) Black and Hispanic patients will less frequently than white patients start hemodialysis with an arteriovenous fistula (connecting an artery to a vein for vascular access), a procedure for initial blood flow access known to result in superior outcomes compared with either catheters or arteriovenous grafts, according to a report published online by JAMA Surgery.
End-stage kidney disease affected more than 593,000 people in the United States in 2010 and more than 383,000 of them were treated with hemodialysis, a process that replaces the blood filtering usually done by the kidneys, according to background in the information in the study.
Mahmoud B. Malas, M.D., M.H.S., of the Johns Hopkins Medical Institutions, Baltimore, and coauthors examined national trends in initial hemodialysis access with respect to race/ethnicity further divided by co-existing illnesses, nephrology care and medical insurance status.
Their study was a retrospective analysis of 396,075 patients with end-stage renal disease in the U.S. Renal Data System who started dialysis from 2006 through 2010. The main outcomes of the study were utilization rates of arteriovenous fistula (AVF), arteriovenous graft (AVG) and intravascular hemodialysis catheter (IHC). Most of the patients (55.4 percent) in the study were white, followed by 30.3 percent black patients and 14.3 percent Hispanic patients.
The authors found that more white patients initiated hemodialysis with an AVF than black or Hispanic patients (18.3 percent vs. 15.5 percent and 14.6 percent, respectively), although black and Hispanic patients tended to be younger and had less coronary artery disease, chronic obstructive pulmonary disease and cancer than white patients with an AVF. Regardless of medical insurance status, both black and Hispanic patients started hemodialysis with an AVF less frequently than white patients. AVF utilization at initial hemodialysis also was lower among black patients and Hispanic patients compared with white patients among patients who had nephrology care for longer than one year.
The authors note it is possible black and Hispanic patients with chronic kidney disease may be progressing too quickly to end-stage renal disease to make AVFs a viable initial hemodialysis access option because AVFs generally take six to 12 weeks to mature and grow stronger.
"The racial/ethnic disparities in incident AVF access that we describe deserve elucidation. The high rates of catheter use despite national programs to reverse this trend is unacceptable. ... The sociocultural underpinnings of these disparities deserve investigation and redress to maximize the benefits of initiating hemodialysis via fistula in patients with ESRD [end-stage renal disease] irrespective of race/ethnicity," the study concludes.
(JAMA Surgery. Published online April 29, 2015. doi:10.1001/jamasurg.2014.0287. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Focusing Quality Improvement Efforts for Hemodialysis Access
In a related commentary, Laura A. Peterson, M.D., M.S., and Matthew A. Corriere, M.D., M.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., write: "Their analysis of the U.S. Renal Data System contributes useful insight into racial/ethnic differences in arteriovenous fistula (AVF) utilization, accounting for patient comorbidities, insurance status and health care provider specialty, but the overall rates of AVF use (or more appropriately the lack of AVF use) at first hemodialysis are perhaps the more important and concerning finding. Rates of AVF use at hemodialysis initiation were 18.3 percent, 15.5 percent and 14.6 percent among white, black and Hispanic patients, respectively. These results are especially sobering compared with the 2006 goals from the National Kidney Foundation, including prevalent functional AVF in more than 65 percent of patients and cuffed catheters in less than 10 percent. ... Given the mismatch between goals and current outcomes, the more appropriate quality improvement focus may be lowering the dismal overall catheter rates instead of a less than 5 percent difference in AVF rates between races/ethnicities."
(JAMA Surgery. Published online April 29, 2015. doi:10.1001/jamasurg.2015.0321. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory: To contact corresponding author Mahmoud B. Malas, M.D., call Ekaterina Pesheva at 410-502-9433 or email epeshev1@jhmi.edu or call Karen Tong at 410-550-0128 or email ktong4@jhmi.edu. To contact commentary author Matthew A. Corriere, M.D., call Marguerite Beck at 336-716-2415 or email marbeck@wakehealth.edu.
To place an electronic embedded link to this study in your story: Links will be live at the embargo time: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2014.0287 and http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2015.0321
INFORMATION:
A high-dose treatment of sodium nitrite, 6 percent, with citric acid, 9 percent, creams applied twice daily was more effective than placebo for treating the common sexually transmitted disease of anogenital warts, according to an article published online by JAMA Dermatology.
The warts are caused by infection with human papillomavirus (HPV) types 6 and 11 in more than 90 percent of cases. Topical therapies and surgical removal of the warts are associated with local adverse reactions that include itching, burning, pain and erosions. Recurrence with existing therapies is ...
ITHACA, N.Y. - Imagine a hand-held electronic device - accessible, portable and nearly universal - that could reduce pain and discomfort for patients, and allow doctors the freedom to use less powerful and potentially risky medications to complement anesthesia.
Now reach in your pocket, because chances are you already own one.
According to new research from a team led by Communications and Information Science Professor Jeff Hancock and Cornell doctoral student Jamie Guillory (now at RTI International), the simple act of texting someone on a mobile phone during a minor ...
The National Emphysema Treatment Trial (NETT) was a multicenter, randomized, controlled clinical trial comparing the efficacy of lung volume reduction surgery (LVRS) plus medical management with rehabilitation to medical management plus rehabilitation in patients with severe emphysema. In 2003, the results of NETT demonstrated that LVRS could improve lung function in patients with emphysema, and that the procedure led to improved survival. Yet, adoption of LVRS has been very slow with concerns expressed regarding safety and long-term efficacy. In this presentation, Dr. ...
Every day, thousands of people need donated blood. But only blood without A- or B-type antigens, such as type O, can be given to all of those in need, and it's usually in short supply. Now scientists are making strides toward fixing the situation. In ACS' Journal of the American Chemical Society, they report an efficient way to transform A and B blood into a neutral type that can be given to any patient.
Stephen G. Withers and colleagues note that currently, blood transfusions require that the blood type of the donor match that of the recipient. If they aren't the same, ...
Marketers often use positive emotions such as hope, pride, love, and compassion interchangeably to encourage people to donate to charitable causes. But these distinct emotions can lead to different results, and love alone has the power to inspire giving to those with whom the giver has no connection, according to a new study in the Journal of Marketing Research.
"Love is unique among positive emotions in fostering a feeling of connectedness," write authors Lisa A. Cavanaugh (University of Southern California), James R. Bettman (Duke University), and Mary Frances Luce ...
When consumers taste cheap wine and rate it highly because they believe it is expensive, is it because prejudice has blinded them to the actual taste, or has prejudice actually changed their brain function, causing them to experience the cheap wine in the same physical way as the expensive wine? Research in the Journal of Marketing Research has shown that preconceived beliefs may create a placebo effect so strong that the actual chemistry of the brain changes.
"Studies have shown that people enjoy identical products such as wine or chocolate more if they have a higher ...
The global industrial sector accounts for more than half of the total energy used every year. Now scientists are inventing a new artificial photosynthetic system that could one day reduce industry's dependence on fossil fuel-derived energy by powering part of the sector with solar energy and bacteria. In the ACS journal Nano Letters, they describe a novel system that converts light and carbon dioxide into building blocks for plastics, pharmaceuticals and fuels -- all without electricity.
Peidong Yang, Michelle C. Y. Chang, Christopher J. Chang and colleagues note that ...
Psychology, biology, and mathematics have come together to show that the occurrence of altruism and spite - helping or harming others at a cost to oneself - depends on similarity not just between two interacting individuals but also to the rest of their neighbours.
According to this new model developed by researchers DB Krupp (Psychology) and Peter Taylor (Mathematics and Statistics, Biology) at Queen's and the One Earth Future Foundation, individuals who appear very different from most others in a group will evolve to be altruistic towards similar partners, and only ...
Logic would dictate that consumers receiving new market information would jump at the chance to adjust their investments accordingly. In practice, however, many people associate change with loss of control. They crave the idea of permanence or closure to such an extent that they would rather freeze decisions in place even if, ironically, this puts them more at risk, according to a new study in the Journal of Marketing Research.
"The need for closure plays a central role in the way people make decisions," write authors David Disatnik and Yael Steinhart of Tel Aviv University. ...
When trying to identify "good" customers, managers often ignore those who return products, or might even consider those customers non-ideal, decreasing the resources devoted to them. In the long term, however, satisfactory product return experiences can actually create a valuable long-term customer whose contributions far outweigh the associated costs, according to a new study in the Journal of Marketing Research.
"Product returns are no small part of the firm-customer exchange process, currently costing firms about $100 billion annually," write authors J. Andrew Petersen ...
