A study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN)says that kidney disease patients insured by some federally sponsored national health care organizations are more likely to undergo an important predialysis procedure than patients with other types of insurance.
The results may provide insights into ways to improve kidney-related care for patients before they go on dialysis.
For patients whose kidneys no longer work, hemodialysis performs the work of the kidneys. Experts recommend creating an arteriovenous fistula (AVF), to connect a vein and artery and allow access to the vascular system. An AVF provides a long-lasting site through which blood can be removed and returned during the dialysis procedure, which patients must undergo 3-4 times per week.
While AVF use for hemodialysis access is safe, cost-effective, and associated with improved survival in kidney disease patients, only a minority of US patients start hemodialysis with an AVF (13.7% in 2008).
Frank Hurst, MD (Walter Reed Army Medical Center and F. Edward Hebert School of Medicine) and his colleagues evaluated the use of AVFs in federally sponsored national health care organizations such as the Departments of Veterans Affairs (DVA) and Department of Defense (DoD). Dr. Hurst and his team searched the United States Renal Data System (USRDS) database to identify patients who initiated hemodialysis between 2005 and 2006. They found that patients who received predialysis kidney care were 10 times as likely to begin dialysis with an AVF compared with patients who did not receive such care. Patients with DVA/DoD insurance were 40% more likely to initiate dialysis with an AVF compared with patients with other types of insurance. Specifically, 27.2% of patients with DVA/DoD insurance initiated hemodialysis with an AVF, compared with 18.5% of patients reporting employer-group insurance, 16.7% of patients with "Other" insurance, 15.6% of patients with Medicare, 13.0% of patients with Medicaid, and 8.2% of patients who reported no insurance. The analysis also revealed that patients who initiated hemodialysis at a DoD facility were twice as likely to use an AVF.
