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Effect of ethnicity and socioeconomic status on vascular access provision and performance in an urban NHS hospital.

Wilmink, Teun and Wijewardane, Anika and Lee, Kathryn and Murley, Alexander and Hollingworth, Lee and Powers, Sarah and Baharani, Jyoti (2017) Effect of ethnicity and socioeconomic status on vascular access provision and performance in an urban NHS hospital. Clinical kidney journal, 10 (1). pp. 62-67. ISSN 2048-8505. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://academic.oup.com/ckj/article-lookup/doi/10...

Abstract

BACKGROUND

The aim of this study was to examine the effect of ethnicity, socioeconomic group (SEG) and comorbidities on provision of vascular access for haemodialysis (HD).

METHODS

This was a retrospective review of two databases of HD sessions and access operations from 2003-11. Access modality of first HD session and details of transplanted patients were derived from the renal database. Follow-up was until 1 January 2015. Primary failure (PF) was defined as an arteriovenous fistula (AVF) used for fewer than six consecutive dialysis sessions. AVF survival was defined as being until the date the AVF was abandoned. Ethnicity was coded from hospital records. SEG was calculated from postcodes and 2011 census data from the Office of National Statistics. Comorbidities were calculated with the Charlson Comorbidity Index.

RESULTS

Five hundred incident patients started chronic HD in the study period. Mode of starting HD was not associated with ethnicity (P = 0.27) or SEG (P = 0.45). Patients from ethnic minorities were younger when starting dialysis (P < 0.0001). Some 928 AVF patients' first AVF operations were analysed: 68% Caucasian, 26% Asian and 6% Afro-Caribbean. Half were in the most deprived SEG and 11% in the least deprived SEG. PF did not differ by ethnicity (P = 0.29), SEG (P = 0.75) or comorbidities (P = 0.54). AVF survival was not different according to ethnicity (P = 0.13) or SEG (P = 0.87). AVF survival was better for patients with a low comorbidity score (P = 0.04). The distribution of transplant recipients by ethnic group and SEG was similar to the distributions of all HD starters.

CONCLUSION

Ethnicity and socioeconomic group had no effect on mode of starting HD, primary AVF failure rate or AVF survival. Ethnic minorities were younger at start of dialysis and at their first AVF operation.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Renal
Planned IP Care > Vascular
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Depositing User: Mrs Caroline Tranter
Date Deposited: 30 Jun 2017 13:20
Last Modified: 30 Jun 2017 13:20
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1432

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