RATIONALE & OBJECTIVE Racial and ethnic differences exist in the type of arteriovenous access (AVA, including fistulas and grafts) used at hemodialysis (HD) initiation. The preferred anatomic location for the creation of an initial HD AVA is typically in the forearm We evaluated racial and ethnic differences in the use of an AVA in the forearm location at HD initiation. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using records from DaVita Kidney Care linked to the United States Renal Data System (USRDS), we evaluated patients aged ≥16 years who initiated in-center HD with an AVA between 2006 and 2019. PREDICTOR Race/ethnicity, categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Other. OUTCOME Forearm vs. upper arm AVA location. ANALYTICAL APPROACH Multivariable modified Poisson regression to estimate adjusted trends in AVA location over time and racial/ethnic differences in AVA location. Nested models helped assess the relative confounding by groups of variables on estimates of racial/ethnic differences. RESULTS Among 70,147 patients (51.7% White, 28.8% Black, 12.6% Hispanic, 6.9% Other), White patients were older and more likely to have peripheral vascular disease, but less likely to have diabetes compared to the other groups. The proportion initiating HD using a forearm AVA decreased from 49% in 2006 to 29% in 2019 and by 3.6% (95% CI, 3.3%-3.9%) annually, with no difference in this trend among groups (race/ethnicity by calendar year interaction P=0.32). Black patients were 13% (95% CI, 10%-15%) less likely and Hispanic patients were 5% (95% CI, 1%-9%) less likely than White patients to initiate HD with a forearm AVA. LIMITATIONS Findings may not apply to home HD. CONCLUSIONS Use of a forearm AVA for HD initiation has declined and racial differences have persisted, with Black and Hispanic patients being less likely than White patients to have an AVA in the forearm location. Research towards understanding the causes and consequences of these trends and disparities is warranted.

中文翻译：

---

血液透析开始时使用的动静脉通路的前臂与上臂位置：时间趋势和种族差异。


基本原理和目标 在血液透析（HD）开始时使用的动静脉通路类型（AVA，包括瘘管和移植物）存在种族和民族差异。创建初始 HD AVA 的首选解剖位置通常是前臂 我们评估了在 HD 开始时在前臂位置使用 AVA 的种族和民族差异。研究设计 回顾性队列研究。使用与美国肾脏数据系统（USRDS）相连的DaVita肾脏护理记录，我们评估了2006年至2019年间开始中心内HD治疗的患者年龄≥16岁。预测变量 种族/民族，分类为非西班牙裔白人、非西班牙裔黑人、西班牙裔或其他。结果 前臂与上臂 AVA 位置。分析方法 多变量改良泊松回归，以估计 AVA 位置随时间变化的调整趋势和 AVA 位置的种族/民族差异。嵌套模型有助于评估变量组对种族/民族差异估计的相对混杂。结果 在 70,147 例患者 （51.7% 白人， 28.8% 黑人， 12.6% 西班牙裔， 6.9% 其他） 中，白人患者年龄较大，更容易患有外周血管疾病，但与其他组相比，患糖尿病的可能性较小。使用前臂 AVA 启动 HD 的比例从 2006 年的 49% 下降到 2019 年的 29%，每年下降 3.6% （95% CI，3.3%-3.9%），这一趋势在组间没有差异 （按日历年交互作用的种族/民族 P=0.32）。与白人患者相比，黑人患者使用前臂 AVA 启动 HD 的可能性低 13% （95% CI，10%-15%），西班牙裔患者 5% （95% CI，1%-9%）。限制 调查结果可能不适用于家庭高清。 结论 使用前臂 AVA 进行 HD 启动的情况已经下降，种族差异仍然存在，黑人和西班牙裔患者比白人患者在前臂位置发生 AVA 的可能性更小。有必要进行研究以了解这些趋势和差异的原因和后果。