Racial/Ethnic Disparities in Home Dialysis Outcomes Identified

Blacks undergoing PD or home HD and Hispanics undergoing PD are less likely than their white counterparts to receive a kidney transplant.
Blacks undergoing PD or home HD and Hispanics undergoing PD are less likely than their white counterparts to receive a kidney transplant.

Researchers have identified racial/ethnic disparities in the likelihood of receiving a kidney transplant among patients undergoing home dialysis.

Compared with whites undergoing peritoneal dialysis (PD), blacks and Hispanics undergoing PD, respectively, had a significant 46% and 48% decreased likelihood of receiving a kidney transplant, after adjusting for age, gender, and diabetes, Rajnish Mehrotra, MD, of the University of Washington in Seattle, and colleagues reported online ahead of print in the Journal of the American Society of Nephrology. Among patients undergoing home hemodialysis (home HD), blacks had a significant 43% decreased likelihood of receiving a kidney transplant compared with whites, but the researchers found no disparity in kidney transplantation among Hispanics, Asians, and other racial/ethnic groups.

Among patients receiving home HD, the finding of a disparity in kidney transplantation only in blacks and no other racial/ethnic minorities compared with whites may be due to the relatively small number of events in these other groups, “making our analyses underpowered to make definitive conclusions.”

In the subgroup of patients receiving in-center HD, all racial/ethnic groups were significantly less likely than whites to receive a transplant.

Dr. Mehrotra's team noted that although racial disparities in access to transplantation are well established and evident in their cohort of patients receiving in-center HD, “the persistence of this difference in the subgroup of patients undergoing PD is surprising.” Patients treated with PD in the United States, they pointed out, are significantly more likely to receive a kidney transplant, “probably because these patients are younger and healthier, have a higher socioeconomic status, and are motivated to engage in self-care—medical and social characteristics that are all associated with a higher probability of receiving a kidney transplant.”

The study population included 17,791 patients undergoing PD, 2,536 undergoing home HD, and 140,389 treated with in-center HD. Blacks undergoing PD or home HD had a significantly higher risk of transfer to in-center HD compared with their white counterparts. The researchers found no significant difference in the risk of transfer to in-center HD between Hispanics and whites treated with PD or home HD. Asians and other racial groups undergoing PD had lower risks for transfer to in-center HD, but the researchers observed no significant difference in risk for these groups treated with home HD compared with whites, Dr. Mehrotra's group reported.

In addition, among patients undergoing PD, every racial/ethnic group had a significantly lower risk of death compared with whites, the study found. Among patients treated with home HD, the risk of death was significantly lower among blacks but similar for other racial/ethnic groups. Among patients receiving in-center HD, the risk of death was significantly lower in every racial/ethnic group compared with whites.

“Our analysis is the first multicenter and nationally representative cohort study to compare the racial/ethnic differences in mortality among patients treated with PD or home HD in the United States,” the authors noted. 

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