Pre-Dialysis Procedure Often Delayed in Poorer
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
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
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
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.
The National Kidney Foundation has more about
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