title: Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States.
abstract: Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n =: 162,050, of which 17,791 underwent PD and 2536 underwent home HD for ≥91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; rmehrotr@uw.edu.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California;
authors.forename: Melissa
authors.initials: M
authors.lastname: Soohoo
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Rivara
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: University of Utah, Salt Lake City, Utah;
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.affiliation: Department of Medicine, University of California, Los Angeles, California;
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Department of Medicine, University of California, Los Angeles, California; DaVita Health Partners, El Segundo, California; and Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, Tennessee.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California;
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ravel
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California;
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;
authors.forename: Sooraj
authors.initials: S
authors.lastname: Kuttykrishnan
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: DaVita Health Partners, El Segundo, California; and Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, Tennessee.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California;
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D001741:Black or African American; D000368:Aged; D001213:Asian; D044466:Asian People; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006437:Hemodialysis, Home / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States; D044465:White People
keywords: end-stage renal disease; hemodialysis; peritoneal dialysis