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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.

Pre-dialysis nephrology care and kidney replacement therapy (KRT)-directed education (KDE) are crucial for starting home dialysis.

Researchers conducted a retrospective study analyzing the impact of disparities in these aspects of care on the underuse of home dialysis. 

They analyzed the 2021 U.S. Renal Database System, focusing on adult patients with kidney failure with over 6 months of pre-dialysis Medicare coverage who started dialysis between 2010 and 2019. The mediation analysis method was used to explore how disparities in nephrology care and KDE affect home dialysis use, and sensitivity analyses were conducted to assess the impact. 

The results showed that among the 464,310 Medicare recipients, 428,201 used in-center hemodialysis, and 35,416 used home dialysis. Patients with Hispanic identity (n=49,734) had lower odds for pre-dialysis nephrology care (0.62, 95% CI: 0.61-0.64), KDE services (0.58, 95% CI: 52-0.63), home dialysis (0.76, 95% CI: 0.73-0.79), compared to non-Hispanic Whites (n=294,914). Black patients (n=98,992) had odds of 0.74 (95% CI: 0.73-0.76) for nephrology care, 0.84 (95% CI: 0.79-0.89) for KDE, and 0.63 (95% CI: 0.61-0.65) for home dialysis. Lack of nephrology care explained 30% of home dialysis underuse among Hispanics and 14% among Blacks. Sensitivity analyses supported these findings with longer nephrology care durations. 

Investigators concluded that disparities in pre-dialysis nephrology care are strongly linked to lower rates of home dialysis among people with Hispanic and Black identities.

Source: journals.lww.com/jasn/abstract/9900/race_and_ethnicity_related_disparities_in.417.aspx