Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States
Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States
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DOI：
10.1681/asn.2015050472
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发表时间：
2016-07-01
影响因子：
13.6
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Mehrotra, Rajnish;Soohoo, Melissa;Kalantar-Zadeh, Kamyar
家庭透析包括腹膜透析 (PD) 或家庭血液透析 (家庭 HD)，为 ESRD 患者提供了更大的灵活性和独立性。尽管终末期肾病对少数种族/族裔的影响尤为严重，但有关家庭透析使用和结果差异的数据却很少。我们分析了 2007 年至 2011 年间开始维持性透析并入住由单一大型透析组织运营的 43 个州 2217 个透析机构中任意一个的患者的数据，并随访至 2011 年 12 月 31 日（n=162,050，其中 17,791 例接受 PD，2536 例接受家庭 HD，时间≥ 91 天）。每个种族/族裔少数群体接受家庭透析治疗的可能性均明显低于白人。在中心接受 HD 或 PD 治疗的个体中，少数种族/族裔的死亡风险低于白人；在接受家庭 HD 治疗的个体中，只有黑人的死亡风险显着低于白人。与白人相比，接受 PD 或家庭 HD 的黑人转移至中心 HD 的风险较高，而接受 PD 的亚洲人或其他人的风险低于接受 PD 的白人。无论采用何种透析方式，黑人、接受 PD 或中心 HD 的西班牙裔以及接受中心 HD 的亚洲人和其他种族群体接受肾移植的可能性均显着低于白人。总之，美国家庭透析的使用和结果存在种族/民族差异。接受家庭透析的黑人和西班牙裔人的肾移植差异与中心 HD 患者相似。未来的研究应该找出这些差异的可改变的原因。
Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n=162,050, of which 17,791 underwent PD and 2536 underwent home HD for >= 91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.