Pre-Dialysis Procedure Often Delayed in Poorer Communities

THURSDAY, Aug. 5 (HealthDay News) — Kidney disease patients in poor communities are less likely than patients in wealthier areas to receive optimal care before they start dialysis, a U.S. study has found.

Researchers analyzed data from 28,135 patients treated at 1,127 dialysis centers in 16 states between June 1, 2005 and May 31, 2006, and found that patients in poorer communities were less likely to undergo a recommended procedure prior to starting dialysis.

Experts strongly recommend that doctors create an arteriovenous fistula (AVF) in patients with end-stage kidney disease who are about to begin dialysis. An AVF connects a vein and artery, usually in the forearm, to allow an efficient and convenient connection to a dialysis machine and to provide a long-term site for the removal and return of blood, according to background information provided in a news release about the study.

Although new patients at dialysis centers in poorer communities were less likely to receive an AVF, the rates among patients already on dialysis at treatment centers in poorer communities increased substantially over 30 months, from 30.9 percent to 38.6 percent. There was no association between a community’s wealth or poverty and the rate of change in AVF use, the researchers noted.

The study is published in the Aug. 5 online edition of the Journal of the American Society of Nephrology.

The study authors said knowledge about the recommendation among local primary care doctors in poor communities may vary, resulting in delays in referrals for AVF placement. In addition, kidney disease patients in poor communities may have negative opinions, attitudes and beliefs about the value of undergoing AVF surgery prior to starting dialysis.

“The community where a treatment center resides may contribute to variations in pre-dialysis care. This observation provides support for developing ways to improve quality of care in these poorly performing communities and raises questions as to why poverty plays a role in pre-dialysis care, when these variations are not seen following the start of dialysis,” study author Dr. William McClellan, of Emory University, said in a news release from the journal’s publisher.

More information

The National Kidney Foundation has more about dialysis.