Insurance-related disparities in timely access to gold standard dialysis procedure

November 01, 2018

HighlightsWashington, DC (November 1, 2018) -- Patients with newly diagnosed kidney failure must wait for up to 3 months before they qualify for Medicare. A new study found that this short period of time without insurance is associated with delays in the placement and use of preferred methods for gaining access to the bloodstream for dialysis. The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also found that this insurance lag time is linked with a higher risk of later dialysis-related infection.

Individuals in the United States can obtain Medicare insurance coverage no matter how old they are if they have kidney failure that requires dialysis or a kidney transplant; however, when a patient is first diagnosed with kidney failure, they must wait 3 months before they become eligible for Medicare based the kidney failure criteria.

Eugene Lin, MD, MS (Keck School of Medicine of USC) and his colleagues sought to determine whether this short delay without Medicare coverage might lead to delays in the placement and use of arteriovenous fistulas and grafts, which are preferred methods for accessing the bloodstream for dialysis. Using information from a national registry, the researchers compared uninsured patients starting hemodialysis between 2010 and 2013 with similar patients already covered by Medicare or Medicaid.

Patients with Medicare or Medicaid were much more likely to use an arteriovenous fistula or graft by their fourth dialysis month and this difference persisted through the first year of dialysis. Patients with Medicare at the start of dialysis also had fewer hospitalizations involving vascular access infection in dialysis months 4-12. (Individuals who undergo hemodialysis are at increased risk of developing infections due to the repeated need to access their blood.)

"In general, uninsured patients experience disparities in accessing healthcare. Ordinarily, Medicare pays for medical treatments for patients receiving hemodialysis; however, the uninsured must wait for 3 months before being eligible to enroll in Medicare, which makes them vulnerable to delays in medical care," said Dr. Lin. "Our study found that the uninsured were less likely than patients with Medicaid or Medicare to use an arteriovenous fistula or graft in the short-term, and these differences may have persisted even after the uninsured enrolled in Medicare. We also found that uninsured patients were more likely to have a dialysis-related infection than patients with Medicaid."
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Study co-authors include Matthew Mell, MD, MS, Wolfgang Winkelmayer, MD, ScD, and Kevin Erickson, MD, MS.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Health Insurance in the First Three Months of Hemodialysis and Early Vascular Access," will appear online at http://cjasn.asnjournals.org/ on November 1, 2018, doi: 10.2215/CJN.06660518.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 131 countries. For more information, please visit http://www.asn-online.org or contact the society at 202-640-4660.

American Society of Nephrology

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