Prevalence of central venous stenosis among Black and White ESKD patients with dysfunctional dialysis access

Authors

Vipul Chitalia MD, BOSTON UNIVERSITY MEDICAL CENTERFollow
Jonathan RAvid, Cleveland Clinic FoundationFollow
Arinze Nkiruka, Boston University Medical CenterFollow
Kristina Yamkovoy, Boston University Medical CenterFollow
Matthew Diamond, Boston University Medical CenterFollow
Rohit Pillai, Boston University School of MedicineFollow
Tyler J. Ryan, Boston University School of MedicineFollow
Saran Lotfollahzadeh, Boston University Medical CenterFollow
Janice Weinberg, Boston University School of MedicineFollow
Alik Farber, Boston Medical CenterFollow
Rajendran Vivendhan, Boston Medical CenterFollow
Jean Francis, Boston University Medical CenterFollow
Nathanael Fillmore, Boston UniversityFollow
Najia Idrees, Boston UniversityFollow

Keywords

CKD, ESKD, hemodialysis, central venous stenosis

Disciplines

Cardiology | Nephrology | Surgery

Abstract

In the United States, significant racial and ethnic disparities exist in chronic kidney disease (CKD) and its management. Hemodialysis constitutes the main stay of renal replacement therapy for end-stage kidney disease (ESKD), which is initiated using central venous catheters (CVC) in most CKD patients in the United States. Black ESKD patients have higher usage and greater time on CVC for hemodialysis compared to White patients. This trend places Black patients at a potentially higher risk for CVC-related complications such as central venous stenosis (CVS). We posited that Black patients would have a higher prevalence and a greater risk of CVS. A retrospective review was performed of ESKD patients who underwent a fistulogram for dialysis access malfunction. CVS was defined as > 50% stenosis in the central veins. Fistulograms of 428 ESKD patients were adjudicated, and CVS was noted in 167 of these patients. Of the entire cohort, 370 fistulograms belonged to self-reported unique Black and White ESKD patients, of whom 137 patients were noted to have CVS. There was no difference in the of CVS between Black (40%) and White (41%) ESKD patients. However, a higher severity of stenosis (>70%) (P = 0.03) was noted in White ESKD patients. An unadjusted model showed a significant association between CVS and cardiovascular disease and the use of CVCs. The risk-adjusted model showed a significant association between diabetes and CVS. Unlike arterial stenotic lesions, this work for the first time demonstrated higher prevalence of severe venous stenotic lesions in White ESKD patients and linked diabetes to stenotic venous disease. This work paves the way for future studies investigating the risk and influence of race and ethnicity on CVS using a larger and diverse data set.

Permissions

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Recommended Citation

MD, Vipul Chitalia; RAvid, Jonathan; Nkiruka, Arinze; Yamkovoy, Kristina; Diamond, Matthew; Pillai, Rohit; Ryan, Tyler J.; Lotfollahzadeh, Saran; Weinberg, Janice; Farber, Alik; Vivendhan, Rajendran; Francis, Jean; Fillmore, Nathanael; and Idrees, Najia (2023) "Prevalence of central venous stenosis among Black and White ESKD patients with dysfunctional dialysis access," Journal of Health Disparities Research and Practice: Vol. 16: Iss. 3, Article 1.
Available at: https://digitalscholarship.unlv.edu/jhdrp/vol16/iss3/1