Racial disparities in complication rate seen for hospitalized patients with ESKD
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Key takeaways:
- Rates of mechanical, infectious and other complications declined from 2005 to 2018 in patients hospitalized with end-stage kidney disease on dialysis.
- Researchers call for more studies into equitable care.
Although the rate of complications for hospitalized patients with end-stage kidney disease on dialysis declined between 2005 and 2018, patients from underrepresented groups showed higher odds of complications compared with white patients.
According to data published in Kidney International Reports, Black patients and those of “other” races had higher odds of complications, while Hispanic patients had similar odds to white patients.
“Although the literature has shown the existence of disparities in hemodialysis and the prevalence of complications based on the types of hemodialysis, there is limited data on the inequalities of vascular access complications. The objective of this study was to assess the trends in rates of complications, as well as racial disparities, among patients with ESKD on hemodialysis per year,” Waseem Wahood, MS, from Nova Southeastern University, and colleagues wrote.
In a retrospective cohort study, researchers examined 9,246,553 hospital admission cases involving patients with ESKD on hemodialysis between 2005 and 2018. Researchers collected demographic variables, such as age, gender, race, insurance type and Elixhauser comorbidity indices. Data were derived from the National Inpatient Sample, and data on race were available for 91.23% of cases.
Overall, 35.47% of cases involved white patients, 16.09% involved Black patients and 7.60% involved Hispanic patients or patients of another race.
Using the Cochran-Armitage Test, researchers measured trends in the rate of complications per year. An additional test was done to identify rates of complications among each racial and ethnic category. Researchers also conducted a multivariable regression analysis to determine the risk factors connected to mortality, mechanical inflammatory and infections and other complications.
Ultimately, there was a –0.05% decline in mechanical complications per year, a –0.48% decline in inflammatory or infectious complications and a –0.19% decline in other complications among all patients. Compared with white patients, patients from historically underrepresented groups showed a greater magnitude in the decrease in trends in rates of complications at –0.69% per year.
Further, Black patients and those categorized as “other” showed a higher risk of complications. Hispanic patients had similar trends to white patients. Researchers noticed these differences were present among patients of lower socioeconomic classes and those residing in southern states in the U.S.
“Although white patients initiate hemodialysis using central venous catheters, our results showed that non-white patients have higher complication rates. This may be due to comorbid conditions, inequity of pre-dialysis nephrology care and differences in insurance statuses. Our data found this inequity across household income quartiles as well. In addition, arteriovenous fistulas use for hemodialysis remains low, and this may be attributable to limited pre-dialysis nephrology care,” Wahood and colleagues wrote. “Although hemodialysis complication rates are as high as 20%, the rates are decreasing, as evident by our data. This may be the result of dialysis treatment policy reforms, including bundled payment for dialysis in 2010.”
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