Racial/ethnic minorities less likely to be treated with home dialysis compared with whites

There are substantial racial/ethnic differences in use of home dialysis and the health outcomes of U.S. patients who use it, according to a study appearing in the Journal of the American Society of Nephrology (JASN).

To examine whether there are racial/ethnic differences in the use of home dialysis, length of time patients are able to be treated at home, and risk for premature death, Rajnish Mehrotra, MD (University of Washington) and his colleagues analyzed data on 162,050 patients who initiated dialysis between 2007 and 2011 and were admitted to any of 2,217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through 2011. Of these patients, 17,791 underwent peritoneal dialysis and 2,536 underwent home hemodialysis for at least 91 days.

Among the major findings:

Every racial/ethnic minority group was significantly less likely to be treated with home dialysis compared with whites. (For blacks, peritoneal dialysis was 47% lower and home hemodialysis was 51% lower; for Hispanics, peritoneal dialysis was 43% lower and home hemodialysis was 75% lower; for Asians, peritoneal dialysis was 18% lower and home hemodialysis was 47% lower; and for others, peritoneal dialysis was 40% lower and home hemodialysis was 56% lower).

Among individuals treated with peritoneal dialysis or in-center hemodialysis, racial/ethnic minorities had a lower risk of dying than whites. Among individuals undergoing home hemodialysis, only blacks had a significantly lower risk of dying than whites.

Blacks undergoing peritoneal dialysis or home hemodialysis had a higher risk for transfer to in-center hemodialysis than their white counterparts, whereas Asians or others treated with peritoneal dialysis had a lower risk.

Blacks, irrespective of dialysis modality, Hispanics undergoing peritoneal dialysis or in-center hemodialysis, and Asians and other racial groups undergoing in-center hemodialysis were significantly less likely than their white counterparts to receive a kidney transplant.

“There are many potential reasons for lower use of home dialysis among racial/ethnic minorities,” said Dr. Mehrotra. These might include lack of availability of home dialysis in certain communities; insurance barriers for availability of home dialysis; inability of health care teams to discuss various options for treatment because of delayed referral and emergent need for dialysis; provider bias in not offering home dialysis to racial/ethnic minorities; availability of social support or space at home; and patient preference on how treatment should be delivered.

“The challenges with access to transplantation could arise from delayed or no referral by physicians to transplant centers, challenges in completing the work-up related to kidney transplant, and longer time on waiting lists because of limitations with finding an appropriate match,” Dr. Mehrotra explained. -by Rebecca Zumoff

Study co-authors include Melissa Soohoo, Matthew B. Rivara, MD, Jonathan Himmelfarb, MD, Alfred Cheung, MD, Onyebuchi Arah, PhD, Allen Nissenson, MD, Vanessa Ravel, Elani Streja, Sooraj Kuttykrishnan, PhD, Ronit Katz, Miklos Z. Molnar, MD, and Kamyar Kalantar-Zadeh, MD, PhD.