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Abstract: SA-PO049

Applying Sequence Analysis Techniques to Describe ESKD Patients' Treatment Histories

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health


  • Daw, Jonathan, Pennsylvania State University Department of Sociology & Criminology, University Park, Pennsylvania, United States
  • Pessin, Léa, Pennsylvania State University Department of Sociology & Criminology, University Park, Pennsylvania, United States
  • Gillespie, Avrum, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Butler, Catherine, University of Washington School of Medicine, Seattle, Washington, United States

Although outcomes for particular treatments for ESKD have been studied, characterizing full treatment sequences (including timing, order, and duration) for different racial/ethnic groups may offer deeper insights into patient experiences and outcomes.


We study 10-year treatment sequences of the 2009 incident ESKD cohort age 18-44 in the USRDS. The state plot characterizes the distribution of treatments over time; the index plot traces individual patients’ treatment sequences with one line per unique sequence.


State plot: White and Asian groups exhibit higher rates of hemodialysis (especially CAPD and CCPD for Asians) and transplant.
Index plot: More sequences for non-White patients involve uninterrupted hemodialysis than for White patients. More sequences for Black patients involve early loss to follow-up. White patients have more preemptive LDKTs than other groups. Significant shares of sequences for White, Hispanic, and Asian patients begin with CCPD/CCAD before transitioning to other treatments, but this is a smaller share of sequences for Black patients.


Sequence analysis techniques hold potential to more fully describe ESKD patient treatment histories and offer a new insight into racial/ethnic disparities.


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