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Insurance Type May Affect Kidney Patient Predialysis Care

Those with some types of federal insurance more likely to start dialysis with an arteriovenous fistula

FRIDAY, Aug. 13 (HealthDay News) -- Kidney disease patients insured by federally-sponsored national health care organizations such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD) are more likely to begin hemodialysis with an arteriovenous fistula (AVF) than patients with other types of insurance coverage, according to research published online Aug. 12 in the Journal of the American Society of Nephrology.

Frank P. Hurst, M.D., of the Walter Reed Army Medical Center in Washington, D.C., and colleagues used the U.S. Renal Data System database to perform a cross-sectional analysis of patients who started hemodialysis between 2005 and 2006.

The investigators found that patients who underwent predialysis nephrology care experienced a 10-fold greater odds of starting dialysis with an AVF (adjusted odds ratio [aOR], 10.3). In addition, DVA/DoD insurance was independently linked to beginning hemodialysis with an AVF (aOR, 1.4), with 27.2 percent of patients with DVA/DoD insurance initiating hemodialysis with an AVF. Although fewer patients at a DoD facility started hemodialysis, DoD patients were more likely to use an AVF (aOR, 2.3).

"In conclusion, patients in DVA/DoD systems are significantly more likely to use an AVF at initiation of hemodialysis than patients with other insurance types, including Medicare. Further study of these federal systems may identify practices that could improve processes of care across health care systems to increase the number of patients who initiate hemodialysis with an AVF," the authors write.

One author is an employee of Davita Inc., a provider of dialysis services.

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