BACKGROUND Despite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC). METHODS To better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013. RESULTS At 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft. CONCLUSIONS Female patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

中文翻译：

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美国医疗保险人口中使用导管和透析途径的种族和性别差异。

背景技术尽管努力增加动静脉瘘和移植物的使用，但是在美国，仍有80％的患者开始在中央静脉导管（CVC）上进行血液透析。方法为了更好地了解事件性血液透析患者的性别和种族/民族与中心静脉导管上的时间以及过渡到动静脉瘘和移植物的时间有何关系，我们的观察性队列研究分析了美国肾脏数据系统对年龄≥66岁的ESKD患者的数据从2010年7月至2013年，开始在CVC上进行血液透析的年数。结果在1年中，74,194例患者中有32.7％转变为动静脉瘘，10.8％转变为动静脉移植物，32.1％保留在CVC上，而24.5％死亡。女性在CVC上花费的时间比男性长得多。与白人患者相比，黑人，西班牙裔，或其他种族/民族少数群体在CVC上花费的时间明显更多。在竞争性风险消退中，女性比男性更不可能转换为瘘管，而更有可能转换为移植物。与白人患者相比，黑人患瘘的可能性要小得多，而移植物的可能性要高得多，西班牙裔患瘘的可能性要高得多，而其他种族/族裔的患病可能性要高得多。或嫁接。结论女性患者花在CVC上的时间更长，并且不太可能过渡到永久使用。与白人患者相比，少数族裔在CVC上花费的时间也更长，但最终过渡到永久性访问的可能性更大。