Educational Attainment and Outcomes of Hemodialysis Access Creation

Abstract

Objective

Higher education has historically correlated with improved health outcomes, yet its impacts on end-stage renal disease (ESRD) patients undergoing hemodialysis are not well understood. The goal of this study was to characterize patient factors and outcomes associated with initial arteriovenous (AV) access creation by patient education level.

Methods

We performed a single-center retrospective review of patients who underwent initial AV access creation from 2014-2021. Education groups were defined as primary (elementary school), secondary (middle/high school equivalent), and tertiary (college or higher). Univariable, multivariable, and Kaplan-Meier analyses were performed.

Results

We identified 480 patients with primary (20.2%), secondary (54.6%), or tertiary education levels (25.2%). Patients with primary education were more likely to be of Hispanic ethnicity (58.8% primary vs 17.9% secondary vs 9.9% tertiary; P < 0.0001) or underinsured (Medicaid/uninsured) (62.9% vs 46.2% vs 39.7%; P < .001), but less likely to have English proficiency (27.1% vs 79.4% vs 77.5% tertiary; P < .001).

Univariable analysis showed no significant differences in access-related steal or 30-day readmission. On Kaplan-Meier analysis, 2-year survival was 89.5% (primary education), 89.1% (secondary education), and 89.7% (tertiary education) (P = .99). Maturation at 180 days was 80.8%, 75.4%, and 75.3%, respectively (P = .4). On multivariable analysis, neither 30-day index readmission nor loss of primary patency were significantly associated with education level.

Conclusions

Although education level was not associated with adverse outcomes once patients were undergoing hemodialysis, many of our patients only have primary school education. Earlier attempts at improving healthcare literacy and preventative care should be examined before the deterioration of kidney function.