Disparities in Predialysis Nephrology Care Impact Vascular Access Outcomes

Recent research has highlighted significant system-based disparities in access to nephrology care before dialysis initiation, which directly influence the success of establishing vascular access for hemodialysis patients. A study published online on September 5, 2025, in JAMA Network Open examined how these disparities particularly affect Hispanic populations. The investigation revealed that Hispanic patients are less likely to receive predialysis nephrology care, which substantially reduces their chances of developing a mature, usable arteriovenous access such as fistulas or grafts, essential for effective hemodialysis.

The retrospective analysis utilized data from the 2021 U.S. Renal Database System, comprising over 427,000 patients undergoing incident hemodialysis. It identified that only 14.5% of patients received arteriovenous fistulas, with a significant portion predominantly relying on central venous catheters—about 82.2%. Hispanic patients showed lower odds of receiving nephrology care and subsequent vascular access compared to White patients. Specifically, lack of predialysis nephrology care accounted for over 32% of cases where vascular access was underused and more than 62% of instances where vascular access was not yet matured.

Importantly, the study found that Hispanic individuals with central venous catheters or those with maturing fistulas or grafts had a higher likelihood of converting to a functional arteriovenous access within the first year of dialysis, but these conversions were negatively influenced by disparities in pre-dialysis care. The authors emphasized the importance of further mechanistic, hypothesis-driven studies to understand the key factors contributing to these outcomes.

The findings underscore the critical need for targeted interventions to reduce disparities in nephrology care prior to dialysis, which could improve vascular access success rates and overall kidney failure management among minority populations.