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The following is a summary of “Race-and Ethnicity-Related Disparities in Predialysis Nephrology Care, Kidney Disease Education, and Home Dialysis Utilization,” published in the September 2024 issue of Nephrology by Shukla et al.
Researchers conducted a retrospective study evaluating the association between pre-dialysis nephrology care and kidney replacement therapy (KRT)-directed education (KDE) disparities and incident home dialysis use.
They analyzed the 2021 US Renal Database System to identify all adult patients with kidney failure with over 6 months of pre-dialysis Medicare coverage initiating their first-ever dialysis (2010 and 2019). Mediation analysis was used to dissect the attributable influence of disparities in pre-dialysis nephrology care and KDE on incident home dialysis use.
The results showed 464,310 recipients of Medicare, with 428,301 opting for in-center hemodialysis and 35,416 choosing home dialysis as the initial modality. Compared to patients that were non-Hispanic White (n=294,914), the aOR (95% CI) for receiving pre-dialysis nephrology care, Kidney Disease Education (KDE) services, and incident home dialysis were 0.62 (0.61, 0.64), 0.58 (0.52, 0.63), and 0.76 (0.73, 0.79) respectively for individuals that were Hispanic (n=49,734), and 0.74 (0.73, 0.76), 0.84 (0.79, 0.89), and 0.63 (0.61, 0.65) respectively for Black individuals (n=98,992). Mediation analyses indicated that the lack of nephrology care accounted for 30% and 14% of home dialysis underuse among Hispanic and Black individuals, respectively (P<0.001). Sensitivity analyses confirmed and supported these findings by considering longer durations of nephrology care and KDE services and assessing the impact on home dialysis underuse through the first year of post-kidney failure.
They concluded disparities in pre-dialysis nephrology care were significantly associated with lower home dialysis among Hispanic and Black individuals.
Source: journals.lww.com/jasn/abstract/9900/race_and_ethnicity_related_disparities_in.417.aspx