Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy.
BACKGROUND
Many patients initiate renal replacement therapy with suboptimal anemia management. The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy.


METHODS
Using data from the medical evidence form filed for patients who initiated renal replacement therapy between 1995-2003, we assessed racial and ethnic differences in pre-end-stage renal disease hematocrit levels, the use of erythropoiesis stimulation agents (ESAs), the proportion of patients with hematocrit levels > or = 33% and the proportion of patients with hematocrit levels < 33% that did not receive ESA. We also examined secular trends in racial and ethnic differences in these parameters.


RESULTS
In multivariable analyses, non-Hispanic blacks had lower hematocrit levels (delta hematocrit = -0.97%, 95% CI: -1.00-0.94%), and were less likely to receive ESA (OR = 0.82, 95% CI: 0.81-0.84), to initiate renal replacement therapy with hematocrit > or = 33% (OR = 0.78, 95% CI: 0.77-0.79) or to receive ESA if the hematocrit was < 33% (OR = 0.79, 95% CI: 0.77-0.80) than non-Hispanic whites. White Hispanics also had lower hematocrit levels (delta hematocrit = -0.42%, 95% CI:-0.47% to -0.37%), and were less likely to receive ESA (OR = 0.86, 95% CI: 0.85-0.88), to have hematocrit levels > or = 33% (OR = 0.91, 95% CI: 0.89-0.93) or to receive ESA if the hematocrit was < 33% (OR = 0.85, 95% CI: 0.83-0.87) than non-Hispanic whites. These disparities persisted over the eight-year study period.


CONCLUSIONS
African-American race and Hispanic ethnicity are associated with suboptimal pre-end-stage renal disease anemia management. Efforts to improve anemia care should incorporate targeted interventions to decrease these disparities.
Weisbord
Steven D
SD
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Mailstop 111F-U, 7E Room 120, Pittsburgh, PA 15240, USA. weisbordsd@upmc.edu
Fried
Linda F
LF
Mor
Maria K
MK
Resnick
Abby L
AL
Kimmel
Paul L
PL
Palevsky
Paul M
PM
Fine
Michael J
MJ
D001741:Black or African American; D000740:Anemia / Q000208:ethnology / Q000628:therapy*; D001799:Blood Sedimentation; D003430:Cross-Sectional Studies; D004921:Erythropoietin; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006400:Hematocrit; D006630:Hispanic or Latino; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D017582:Renal Replacement Therapy; D012923:Social Class; D012935:Social Justice; D014481:United States
D011994:Recombinant Proteins; D004921:Erythropoietin