Abstract: SA-OR037

Pre-ESRD Nephrology Care Associated with Larger Survival Benefit for Black Compared to White Patients on Hemodialysis (HD)

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular


  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • Assari, Shervin, University of Michigan, Ann Arbor, Michigan, United States
  • He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Stack, Austin G., Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States

Recent literature suggests that psychosocial resources, medical risk factors, and treatments may have differential effects across racial groups. We sought to compare the potential impact of pre-ESRD Nephrology care on all-cause mortality by race (Black versus White) among patients newly enrolled in the United States Renal Data System (USRDS) over the last decade.


Using data on 791,248 incident HD patients initiating treatment from 2006-2015, we examined the association between pre-ERSD Nephrology care (defined as ‘no care’ versus ‘any pre-ESRD nephrology care’) on long-term survival, adjusting for age, sex, and comorbidities for both Black and White race groups. Cox regression was used to test the multiplicative effect of race and pre-ESRD care, by interaction. Patients were followed for mortality through 2015 (average follow-up was 2.8 years).


Overall, fewer Black patients had pre-ESRD Nephrology care compared to White patients (53.1% vs. 60.1%). Although pre-ESRD care was associated with lower hazard of mortality in both race groups (p<0.0001), a significant interaction was found, i.e., lower hazard for mortality was associated with Pre-ESRD care for Black (HR=0.73) versus White patients (HR=0.81; p for interaction <0.0001). Survival curves are shown in the Figure.


This finding advocates for promotion of Pre-ESRD care for Black patients, particularly given their lower chance of getting such services, compared to Whites. Future work will expand this to study other race categories and Hispanic ethnicity to gain insight into differential health gain across sub-populations to guide public health priorities toward reducing disparities.


  • NIDDK Support