Expanded Prospective Payment System and Use of and Outcomes with Home Dialysis by Race and Ethnicity in the United States

We investigated whether the recent growth in home dialysis use was proportional among all racial/ethnic groups and also whether there were changes in racial/ethnic differences in home dialysis outcomes. This observational cohort study of US Renal Data System patients initiating dialysis from 2005 to...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology Vol. 14; no. 8; p. 1200
Main Authors: Shen, Jenny I, Erickson, Kevin F, Chen, Lucia, Vangala, Sitaram, Leng, Lynn, Shah, Anuja, Saxena, Anjali B, Perl, Jeffrey, Norris, Keith C
Format: Journal Article
Language:English
Published: United States 07.08.2019
Subjects:
Adult
Aged
Asian
Black or African American
Cohort Studies
Ethnicity
Female
Hemodialysis, Home - economics
Hemodialysis, Home - statistics & numerical data
Hispanic or Latino
Humans
Male
Middle Aged
Procedures and Techniques Utilization - economics
Procedures and Techniques Utilization - statistics & numerical data
Prospective Payment System
United States
White People
United States
disparities
Prospective Payment System
modality selection
ethnicity
race
Hispanic Americans
home dialysis
European Continental Ancestry Group
Logistic Models
Hemodialysis, Home
Asian Continental Ancestry Group
Ethnic Groups
outcomes
peritoneal dialysis
Odds Ratio
technique failure
temporal trends
renal dialysis
Cohort Studies
ISSN:1555-905X, 1555-905X
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Summary:We investigated whether the recent growth in home dialysis use was proportional among all racial/ethnic groups and also whether there were changes in racial/ethnic differences in home dialysis outcomes. This observational cohort study of US Renal Data System patients initiating dialysis from 2005 to 2013 used logistic regression to estimate racial/ethnic differences in home dialysis initiation over time, and used competing risk models to assess temporal changes in racial/ethnic differences in home dialysis outcomes, specifically: ( ) transfer to in-center hemodialysis (HD), ( ) mortality, and ( ) transplantation. Of the 523,526 patients initiating dialysis from 2005 to 2013, 55% were white, 28% black, 13% Hispanic, and 4% Asian. In the earliest era (2005-2007), 8.0% of white patients initiated dialysis with home modalities, as did a similar proportion of Asians (9.2%; adjusted odds ratio [aOR], 0.95; 95% confidence interval [95% CI], 0.86 to 1.05), whereas lower proportions of black [5.2%; aOR, 0.71; 95% CI, 0.66 to 0.76] and Hispanic (5.7%; aOR, 0.83; 95% CI, 0.86 to 0.93) patients did so. Over time, home dialysis use increased in all groups and racial/ethnic differences decreased (2011-2013: 10.6% of whites, 8.3% of blacks [aOR, 0.81; 95% CI, 0.77 to 0.85], 9.6% of Hispanics [aOR, 0.94; 95% CI, 0.86 to 1.00], 14.2% of Asians [aOR, 1.04; 95% CI, 0.86 to 1.12]). Compared with white patients, the risk of transferring to in-center HD was higher in blacks, similar in Hispanics, and lower in Asians; these differences remained stable over time. The mortality rate was lower for minority patients than for white patients; this difference increased over time. Transplantation rates were lower for blacks and similar for Hispanics and Asians; over time, the difference in transplantation rates between blacks and Hispanics versus whites increased. From 2005 to 2013, as home dialysis use increased, racial/ethnic differences in initiating home dialysis narrowed, without worsening rates of death or transfer to in-center HD in minority patients, as compared with white patients.
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ISSN:1555-905X
1555-905X
DOI:10.2215/CJN.00290119