A Systematic Review and Meta-Analysis of Racial Disparities in Hemodialysis Vascular Access Utilization and Outcomes in the United States.

Abstract

This systematic review compares the utilization and outcome of hemodialysis vascular access among racial groups in the United States, highlighting disparities and their implications. The original search using Medline, Embase, Cochrane, and PubMed yielded 349 studies, of which 32 met inclusion criteria. Data on utilization rate, patency, maturation, complications, and survival rate were collected. In pooled analyses, Black patients had significantly lower odds of receiving fistula (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.58-0.77) but twice the odds of receiving grafts (OR 2.01, 95% CI 1.60-2.53) for access than White patients. No statistically significant difference in the odds of dialysis catheter existed between the two groups (OR 0.89, 95% CI 0.66-1.19). According to 7 of 32 studies, Black patients also experienced a higher risk of fistula failure, lower rate of fistula maturation, higher risk of graft and fistula patency loss, and higher complications compared with White patients. Pooled analyses showed no statistically significant difference in the odds of fistula use between White and Hispanic patients (OR 0.93, 95% CI 0.76-1.15). According to 5 of 32 studies, Hispanic patients experienced slightly higher rate of grafts, slightly higher probability of fistula maturation, and slightly better patency rates for both grafts and fistulas than White patients. Mortality rates after vascular access procedures were higher in White than all non-White patients combined. Data regarding vascular access in other racial and ethnic minorities were limited. Overall, Black patients disproportionately received inferior hemodialysis vascular access choices and experienced worse outcomes. These findings highlight the need for interventions to address hemodialysis care disparities in the United States.