Racial disparities strongest among young adults on home dialysis, transplant recipients
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Racial and ethnic disparities in kidney replacement therapies were most pronounced among patients aged 22 to 44 years who are either transplant recipients or on home dialysis, according to data in the American Journal of Kidney Diseases.
“Research has shown wide racial and ethnic disparities in use of kidney transplant and home dialysis, yet how age interacts with these disparities is unknown,” Adam S. Wilk, PhD, and colleagues wrote.
In a retrospective cohort study, researchers compared use of kidney replacement therapies between racial and ethnic groups by examining data for 830,402 adults older than 21 years who initiated kidney failure treatment between 2011 and 2018. Data was taken from the U.S. Renal Data System. Data regarding patients’ race and ethnicity were derived from the Medical Evidence Form (CMS-2728), which was collected at incidence of kidney failure.
Researchers established dichotomous outcome measures to mirror common decision-making hierarchies regarding kidney failure treatment alternatives offered by dialysis facilities. Researchers included patients using a modality for at least 60 days and considered the treatment modality used at day 90 of treatment to be the primary outcome.
Researchers quantified differences in treatment modalities for patient subgroups defined by race and ethnicity and by age. Using log-binomial regression models, researchers estimated adjusted risk ratios.
Overall, researchers determined 81% of patients were treated with in-center hemodialysis, 3% underwent transplants (85% preemptive, 57% living-donor), 10.5% were treated with peritoneal dialysis and 0.7% were treated with home hemodialysis.
Among “non-Hispanic white” patients, the percent of treatment with transplant, peritoneal dialysis and hemodialysis were 10.9%, 19% and 1.2%, respectively. Similarly, “non-Hispanic Black” patients were less commonly treated with each modality (unadjusted percentages, 1.8%, 13.8% and 0.6%, respectively), as were Hispanic patients (4.4%, 16.9% and 0.5%, respectively.)
Although researchers identified racial and ethnic disparities in the 22- to 44-age group, patients in that age group receiving a transplant showed the largest relative disparities.
“Relative and absolute racial and ethnic disparities in preferred kidney failure treatments are generally the worst among younger patients, particularly those aged 22 to 44 years,” Wilk and colleagues wrote. “Using this information, interventions to reduce disparities in access to preferred kidney replacement therapies can be targeted to younger patient groups who stand to gain the most in accumulated life expectancy and quality of life when receiving a preferred kidney failure treatment.”
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