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Invited Commentary
June 2015

Focusing Quality Improvement Efforts for Hemodialysis Access

Author Affiliations
  • 1Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • 2Department of Vascular and Endovascular Surgery and Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
JAMA Surg. 2015;150(6):536-537. doi:10.1001/jamasurg.2015.0321

Racial/ethnic disparities related to hemodialysis access (a key survival determinant among patients with end-stage renal disease) are both a cause for alarm and a call to action, but these findings are hardly surprising. In fact, race/ethnicity and sex-based outcomes disparities are so commonly identified in surgical outcomes research that their absence from an area of clinical evidence should prompt suspicion of inadequate investigation. Although one might hypothesize that the disparities related to incident hemodialysis access in the study by Zarkowsky et al1 in this issue of JAMA Surgery may result from anatomic, physiological, or risk factors, the omnipresence of disparities across diseases and populations may instead reflect broader systems issues related to access, health literacy, and socioeconomics.

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