ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: SA-PO056

Racial and Socioeconomic Differences in Success on Home Dialysis

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Moore, Catherine A., University of Rochester Medical Center, Rochester, New York, United States
  • Liu, Catherine W., University of Rochester Medical Center, Rochester, New York, United States
  • Weissberg, Justin C., University of Rochester Medical Center, Rochester, New York, United States
  • Phan, Tramanh, University of Rochester Medical Center, Rochester, New York, United States
  • Skrill, David, University of Rochester Medical Center, Rochester, New York, United States
  • Reddy, Sai Subhodhini, University of Rochester Medical Center, Rochester, New York, United States
  • Yu, Veronica G., Swedish Cherry Hill, Seattle, Washington, United States
  • Sachsenmeier, Eliot, New York University, New York, New York, United States
  • Yang, Hongmei, University of Rochester Medical Center, Rochester, New York, United States
  • Liebman, Scott E., University of Rochester Medical Center, Rochester, New York, United States
Background

Home dialysis offers several advantages to patients and health care systems including improved patient-centered outcomes, lower cost, and equal if not better clinical outcomes. Despite this, utilization of home dialysis remains low. Although home dialysis is not always the ideal modality for patients with End Stage Renal Disease (ESRD), most dialysis patients are viable candidates for this modality. Variance in home dialysis underutilization falls along both racial and socioeconomic lines, with lower home dialysis utilization by racial and ethnic minorities and higher rates among black individuals of transfer to in-center dialysis. Provider fear of adverse outcomes and home dialysis failure remains a barrier to home therapy referral. We investigated whether markers for sociodemographic stress would predict success on home therapy.

Methods

We performed a retrospective cohort study of adult incident ESRD patients from January 1 2015 through December 31 2021 admitted to providers within the University of Rochester division of nephrology (N= 898, including 794 in-center hemodialysis, 39 home-hemodialysis and 65 Peritoneal dialysis) with observation period ending December 31, 2021. Using cox proportional hazards model, we compared race to social deprivation index (derived through Census Tract) as predictors for home dialysis failure (defined by conversion to in-center dialysis or death).

Results

Black and African American patients were more heavily represented amongst subjects starting in-center HD (31% vs 16.3%). There was no significant difference between mean social deprivation index (SDI) or Charlson co-morbidity index (CCI) scores in subjects starting in-center compared to at home. Over the observation period, 128 subjects performed home dialysis for a mean of 45 months. None of the variables evaluated were predictors of success on home therapy (age, sex, race, SDI or CCI).

Conclusion

Despite similar markers of medical co-morbidity and sociodemographic stress, fewer non-white patients started dialysis on a home modality compared to in-center. Neither social deprivation nor race predicted success on home therapy. This highlights a disparity in the initial referral process to home therapy which is not supported by commonly cited predictors of adverse outcome.