National Trends in Complications of Vascular Access for Hemodialysis and Analysis of Racial Disparities Among Patients With End-Stage Renal Disease in the Inpatient Setting

Introduction: The aim of this study is to assess the trends in access-related complications, as well as the impact of race on these complications, among admitted patients with end-stage kidney disease (ESKD) receiving hemodialysis. Methods: A retrospective cohort study between 2005 and 2018 was performed using the National Inpatient Sample (NIS). Hospitalizations involving ESKD and hemodialysis were identified. There were 9,246,553 total admissions involving ESKD and hemodialysis, of which 1,167,886 (12.6%) had complications. Trends in complications were assessed and compared among races. Results: There was a decreasing trend in rates of mechanical (trend: −0.05% per year; P < 0.001), inflammatory or infectious (−0.48%; P < 0.001), and other (−0.19%; P < 0.001) complications from 2005 to 2018. Non-White patients had a greater magnitude in the decrease in trends in rates of complications compared to White patients (−0.69% per year vs. −0.57%; P < 0.001). Compared to the White patients, Black patients (odds ratio [OR]: 1.26; P < 0.001) and those of the other races (OR: 1.11; P < 0.001) had higher odds of complications. These differences were also statistically significant among lower socioeconomic classes (75 percentile vs. 0–25 percentile: P = 0.009) and within southern states (vs. Northeast: P < 0.001). Conclusion: Although there was an overall decrease in the trends of dialysis-associated complications requiring hospitalization among ESKD patients receiving hemodialysis, non-White patients have higher odds of complications compared to White patients. The findings in this study emphasize the need for more equitable care for hemodialysis patients.