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Kidney Week

Abstract: PO1254

Disparities in Home Dialysis and Links to Kidney Transplantation: Inequities Among African American ESRD Patients in Detroit, Michigan

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Zachariah, Mareena Susan, Wayne State University School of Medicine, Detroit, Michigan, United States
  • Lupi, Alexa, Michigan State University, East Lansing, Michigan, United States
  • Dawadi, Anurag, Michigan State University, East Lansing, Michigan, United States
  • Vazquez, Ana, Michigan State University, East Lansing, Michigan, United States
  • Lucas, Todd, Michigan State University, East Lansing, Michigan, United States

Group or Team Name

  • Michigan State University
Background

African Americans with ESRD continue to fare worse than their White counterparts for graft and patient survival after kidney transplantation. These disparities may partly reflect differential use of peritoneal dialysis (PD) and hemodialysis (HD) among African Americans who undertake maintenance renal replacement therapy – although PD and preemptive tranplants are linked to longer survival and better kidney transplantation outcomes, emerging studies suggest that African Americans less often receive PD than Whites. The current analysis sought to explore whether disparate use of PD would persist in the context of an inner-city hospital that serves a majority African American patient population, within a predominantly African American city.

Methods

We compiled electronic medical record data from 2012-2018 for African American (n = 1078) and White (n = 155) ESRD patients who initiated maintenance dialysis through either HD or PD. We also compiled data on successful kidney transplantation in these patients, as well as sociodemographic and health status data, including BMI, age, PRA peak, race, sex, diabetes, and hypertension.

Results

Fisher’s exact tests showed that African American patients were 2.28 times more likely to receive HD than PD as compared to White patients (p = .004), and that patients receiving PD were 2.09 times more likely to be transplanted (p = .01). Although attenuated, a robust relationship between PD and kidney transplantation persisted in a logistic regression that controlled for sociodemographic and health status variables (OR = 1.60, p = .10).

Conclusion

Disparities in use of PD can be observed even in the context of an inner-city hospital serving a predominantly African American population. Aligned with the Advancing American Kidney Health initiative to achieve 80% home dialysis by 2025, future research must identify and intervene on patient and clinician factors that contribute to lower PD use among African Americans.