Racial disparities found in stroke prevention for kidney failure, atrial fibrillation patients
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Among patients with kidney failure and atrial fibrillation, racial/ethnic minorities were less likely to fill a prescription for warfarin and were more likely to experience stroke than white patients, according to a recently published study.
“ESRD patients are particularly prone to developing [atrial fibrillation] AF,” Paul L. Kimmel, MD, of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, as well as lead investigator on the study, and colleagues wrote. “The prevalence of AF in the ESRD population has increased over time (from 6% in 1996 to 17% in 2006). The risk of stroke among patients initiating dialysis is approximately [six to] 10 times higher than in the general population, making prevention of stroke an important priority in the management of ESRD patients with AF, particularly considering the threat to quality of life stroke entails.”
According to the researchers, higher stroke rates have been previously documented among minority racial/ethnic groups, but data are lacking on how differences in treatment contribute to these racial disparities in stroke outcomes. Therefore, they conducted a retrospective cohort study of 56,587 patients who initiated hemodialysis between 2006 and 2013 and who subsequently received an atrial fibrillation diagnosis (69% were white; 19% were black; 8% were Hispanic; 3% were Asian).
After 1-year of follow-up, researchers determined black, Hispanic and Asian patients were 13%, 15% and 16% more likely to experience stroke, respectively, than white patients. Respectively, they were also 10%, 17% and 28% less likely to fill a warfarin prescription, which was associated with decreased stroke rates. Further analyses showed that if warfarin distribution was equal to that for white patients, 7%, 10% and 12% of excess strokes could be prevented in black, Hispanic and Asian patients, respectively.
Kimmel told Healio Nephrology that while these findings suggest patients of racial/ethnic minorities are likely to be prescribed these medications less often, the data “can only account for prescriptions filled, not prescriptions written.”
He also emphasized the importance of clinician awareness regarding the racial and ethnic disparities that exist in both the treatment and outcomes for patients with kidney failure and a diagnosis of atrial fibrillation.
“To improve outcomes for all people on dialysis who also have atrial fibrillation, clinicians should carefully consider the risks and benefits of each specific anticoagulation therapy for each individual patient,” he said. “And in the future, carefully designed and controlled clinical trials should aim to give further understanding as to which treatment is best for which patient.” – by Melissa J. Webb
Disclosures: Kimmel reports no relevant financial disclosures.
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