Abstract: FR-PO514
Sex and Racial/Ethnic Differences in Home Hemodialysis Mortality
Session Information
- Home Dialysis, Policy, Novel Approaches
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
- Gupta, Nupur, Indiana University, Bloomington, Indiana, United States
- Christianson, Annette L., University of Cincinnati, Cincinnati, Ohio, United States
- Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
- Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background
Women and minorities constitute substantial portions of the prevalent population of kidney failure patients. Little is known about sex and racial/ethnic differences in mortality among patients with kidney failure on home hemodialysis in the United States.
Methods
Using the United States Renal Data System, we retrospectively evaluated a cohort of 42,849 patients who started home hemodialysis between January 1, 2005, and December 31, 2015. We examined the association of sex and race/ethnicity with the outcome of all-cause mortality using adjusted Cox proportional hazard models and logistic regression models.
Results
In the study cohort, 40.4% were women, and 57.4% were White. Women on home hemodialysis had higher unadjusted death rates (26.9 vs. 22.4 per 100 person-years) as compared to men. There was no difference in adjusted all-cause mortality between men and women, but women had an 8% higher adjusted risk of all-cause mortality at one-year after initiating home hemodialysis (OR 1.08, 1.01-1.15). With regards to race/ethnicity, Hispanic, White, and Blacks had higher unadjusted death rates as compared to Asians and Native Americans (25.1 vs. 24.8 vs. 23.2 vs. 17.4 vs.16.6 per 100 person-years). There was no difference in adjusted all-cause mortality in Black, Hispanic, and Native Americans as compared to Whites, while Asians had a lower risk of all-cause mortality than did Whites (HR, 0.81; CI, 0.72-0.92). There was no difference in adjusted one-year mortality for Asian, Black, Hispanic, and Native American patients, as compared to White patients.
Conclusion
Among patients undergoing home hemodialysis, women have higher one-year mortality than men, and women and men have comparable survival on long-term follow-up after adjusting for other covariates. Compared to Whites, there was no difference in adjusted survival on long-term follow-up for Blacks, Hispanics, or Native Americans, while Asians had better survival. Our results suggest the need for population-wide strategies to overcome differences in home hemodialysis care.
Funding
- Other NIH Support