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Home dialysis increases in United States regardless of patient race/ethnicity
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In recent years, an increasing number of patients with ESKD began using home dialysis, according to a recently published study. This growth was seen among all racial and ethnic groups as racial/ethnic differences in initiating home dialysis narrowed.
“From 2005 to 2013, more people in the U.S. were started on home dialysis,” Jenny Shen, MD, MS, assistant professor of medicine at University of California, Los Angeles and investigator at the Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, told Healio/Nephrology. “Historically, minority patients have been less likely to use home dialysis than non-Hispanic white patients.”
To determine whether the recent growth in home dialysis use was proportional among all racial/ethnic groups, researchers conducted an observational cohort study of 523,526 patients with ESKD, analyzing data from the United States Renal Data System. Also considered were factors related to geographical location (eg, neighborhood variables, urban or rural, hospital service area-levels of access to health care and number of dialysis facilities).
Patients were categorized as white (55%), black (28%), Hispanic (13%) or Asian (4%) and temporal trends were assessed by examining changes between three periods: 2005 to 2007; 2008 to 2010; and 2011 to 2013. In addition to estimating racial/ethnic differences in home dialysis initiation over time, researchers focused on differences in transfer to in-center hemodialysis, mortality and transplantation.
Researchers found that, between 2005 and 2007, 8% of white patients and 9.2% of Asian patients initiated home dialysis compared with 5.7% of Hispanic patients and 5.2% of black patients. Over time, researchers observed an increase in home dialysis use for all patients, with 10.6% of white patients, 14.2% of Asian patients, 9.6% of Hispanic patients and 8.3% of black patients initiating home dialysis between 2011 and 2013.
Regarding patient outcomes, researchers found the rate of transferring to in-center dialysis decreased over time for all patients, but that black patients were consistently more likely to transfer than white patients. In addition, while the transplantation rate decreased for all patients over time, the disparity in transplantation between black patients and Hispanic patients vs. white patients increased with black and Hispanics less likely to be transplanted. Researchers found the mortality rate continues to be lower for minority patients than for white patients.
“More work is needed to understand the reasons that black patients are still less likely to use home dialysis than other racial and ethnic groups,” Shen said. “Also, while racial/ethnic differences in transfer from home dialysis to in-center hemodialysis did not change over time, future research should focus on whether there were temporal changes in disparities in cause-specific transfer rates (ie, transfers due to complications from infections vs. catheters). As the U.S. aims to have 80% of new ESRD patients be either on home dialysis or transplanted by 2025, it's important to know that increasing rates in home dialysis use should be possible in all racial and ethnic groups. The improvement in disparities shows that the racially/ethnically specific attitudes that may have restricted home dialysis use among minorities in the past are not insurmountable.”
In a related editorial, Kerri L. Cavanaugh, MD, MHS, of Vanderbilt University Medical Center in Nashville, Tennessee, wrote: “Fortunately, there is much excitement in kidney disease care at the moment with many private companies investing in the development of new technology, new strategies and this includes home dialysis. Policy continues to favor home dialysis with the recent change that permits use of telehealth for home dialysis care visits not limited to a rural setting. Thus, although disparities remain in the use of home dialysis by race/ethnicity in the U.S., there is optimism that this will be a statistic of the past as we keep it front and center as we show that health equity is an achievable outcome when the many talents, resources and compassion of the nephrology community come together.” – by Melissa J. Webb
Disclosures: Shen reports receiving honorarium from Baxter Healthcare. Please see the study for all other authors’ relevant financial disclosures.
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