Investigators have identified racial and ethnic disparities in autosomal dominant polycystic kidney disease (ADPKD) outcomes.
Among 41,485 adults aged 30 years or older with ADPKD in the 2000-2018 US Renal Data System, 77% were White, 13% were Black, and 10% were Hispanic. Black and Hispanic patients experienced kidney failure at significantly younger ages than White patients (55 and 53 years vs 57 years), Rita L. McGill, MD, of the University of Chicago in Illinois and colleagues reported in the Clinical Journal of the American Society of Nephrology. Black and Hispanic patients were typically waitlisted 5-6 months after kidney failure, whereas White patients were waitlisted 3 months before they even reached kidney failure. The proportion of patients waitlisted prior to kidney failure was significantly smaller for the Black and Hispanic populations than the White population (20% and 22% vs 38%, respectively).
The median time from waitlisting to transplantation was significantly longer for Black and Hispanic patients compared with White patients (28 and 24 vs 15 months, respectively).
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In adjusted analyses, Black and Hispanic patients had significant 67% and 50% decreased odds of preemptive kidney transplantation and 39% and 22% decreased odds of transplantation after dialysis initiation, respectively, compared with White patients. Living donor transplants occurred in just 7% and 15% of Black and Hispanic patients compared with 27% of White patients.
Nephrology care prior to kidney failure, private insurance, employment, and higher income increased the odds of both preemptive transplantation and transplantation after dialysis initiation, the investigators reported. Black and Hispanic patients had lower rates of nephrology care before kidney failure (84% and 81% vs 92% of White patients). They also had lower rates of private insurance and employment. Adjustment for clinical and economic variables only partly explained why ADPKD outcomes differ by race, according to the investigators.
In an accompanying editorial, Dinushika Mohottige, MD, and colleagues from Duke University School of Medicine in Durham, North Carolina commented that race disparities in ADPKD outcomes likely apply to other genetic conditions.
“The significant effect of multiple ‘second hits’ from inequitable and systemic failures in kidney care on the kidney health outcomes of minoritized individuals with these genetic conditions cannot be underestimated, and interventions to mitigate these ‘second hits’ are critically needed,” they wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
References
McGill RL, Saunders MR, Hayward AL, Chapman AB. Health disparities in autosomal dominant polycystic kidney disease (ADPKD) in the United States. Clin J Am Soc Nephrol. Published online June 20, 2022. doi:10.2215/CJN.00840122
Mohottige D, McElroy LM, Boulware LE. Addressing “second hits” in the pursuit of greater equity in health outcomes for individuals with ADPKD. Clin J Am Soc Nephrol. Published online June 20, 2022. doi:10.2215/CJN.05970522
