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Abstract: PO1043

Survival Differences Among ESRD Patients in the Mainland United States, Hawaii, and Pacific Islands

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
  • Kataoka-Yahiro, Merle Ritsuyo, University of Hawaii Manoa, Honolulu, Hawaii, United States
  • Davis, James, John A. Burns School of Medicine, Honolulu, Hawaii, United States
  • Hayashida, Glen, National Kidney Foundation Hawaii, Honolulu, Hawaii, United States
  • Page, Victoria, National Kidney Foundation Hawaii, Honolulu, Hawaii, United States
  • Cheng, Shiuh-Feng, John A. Burns School of Medicine, Honolulu, Hawaii, United States
  • Ng, Roland C.K., John A. Burns School of Medicine, Honolulu, Hawaii, United States
  • Wong, Linda L., John A. Burns School of Medicine, Honolulu, Hawaii, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

Asians and Native Hawaiians and other Pacific Islanders (NHOPIs) are collectively the fastest growing racial minorities in the US. While certain Asian subgroups and NHOPIs have a high prevalence of kidney disease risk factors, there are sparse data examining ESRD outcomes in these populations. As Hawaii is among the states with the highest representation of Asians and NHOPIs, we compared ESRD survival among Asians, NHOPIs, and other racial groups residing in the Mainland US vs. Hawaii and the Pacific Islands.

Methods

Using United States Renal Data System (USRDS) data, we examined the impact of geographic residence in the Mainland US vs. Hawaii and the Pacific Islands on associations of race and mortality among incident ESRD patients who transitioned to dialysis over 2010-16. HRs for all-cause mortality were estimated using Cox models adjusted for sociodemographics, comorbidities, dialysis characteristics, pre-ESRD nephrology care, BMI, laboratory tests, and medications.

Results

Compared with White incident ESRD patients residing in the Mainland US, Asians and NHOPIs in the Mainland US had lower mortality risk: HRs (HRs) (95%CIs) 0.67 (0.66-0.67) and 0.72 (0.70-0.73), respectively. When examining Asians and NHOPIs residing in Hawaii and the Pacific Islands, survival benefit was attenuated in Asians and was diminished to the null in NHOPIs (ref: White incident ESRD patients in Mainland US): HRs (95%CIs) 0.77 (0.74-0.79) and 1.00 (0.96-1.03), respectively.

Conclusion

In the Mainland US, Asians and NHOPIs had lower mortality risk compared with Whites. However, in Hawaii and the Pacific Islands, this survival benefit was diminished in Asians and was mitigated in NHOPIs. Further studies are needed to determine the factors contributing to the differential ESRD mortality risk across racial groups residing in the Mainland US vs. Hawaii and the Pacific Islands.

Funding

  • NIDDK Support