Issue: December 2018
Perspective from Michael Allon, MD
Source/Disclosures
Source:

Lin E, et al. Clin J Am Soc Nephrol.2018;doi:10.2215/CJN.06660518.

November 01, 2018
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Insurance-related disparities in dialysis linked with risk of vascular access infections

Issue: December 2018
Perspective from Michael Allon, MD
Source/Disclosures
Source:

Lin E, et al. Clin J Am Soc Nephrol.2018;doi:10.2215/CJN.06660518.

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Eugene Lin
Eugene Lin

According to recently published results, insurance-related disparities in the use of arteriovenous fistulas and grafts in patients who underwent dialysis continued through the fourth month of dialysis and may not fully correct after patients obtain Medicare coverage. In addition, these disparities were linked to greater risk of vascular access infections.

“Patients starting hemodialysis must wait for up to 3 months before they qualify for Medicare,” Eugene Lin, MD, MS, told Healio.com/Nephrology. “This short period of time without insurance is associated with delays in the placement and use of arteriovenous fistulas and grafts when compared to patients with Medicaid or Medicare on the first day of dialysis. Even though the period of time without insurance is short-lived, the disparity in arteriovenous fistula and graft use continues to persist through the first year of hemodialysis. Compared to the Medicare population, the delay in fistula and graft use was associated with increased infections in the uninsured.”

Lin and colleagues used a national registry in a retrospective cohort study to compare uninsured patients with ESKD who began in-center hemodialysis with a central venous catheter with similar patients with Medicare or Medicaid. Investigators assessed whether insurance status at dialysis start impacted the likelihood of a patient switching to dialysis through an arteriovenous fistula or graft and hospitalizations involving a vascular access infection.

Results showed patients with Medicare or Medicaid compared with those who were uninsured were more likely to switch to an arteriovenous fistula or graft by the fourth dialysis month. Investigators noted after all patients had obtained Medicare in their fourth dialysis month, no differences were seen in the rates of patients who switch to arteriovenous fistula or graft. At the start of dialysis, patients with Medicare had fewer hospitalizations that involved vascular access in dialysis months 4 to 12. – by Monica Jaramillo

 

Disclosure s : The authors report no relevant financial disclosures.