Researchers Breakdown Race and Ethnicity Data for End-Stage Kidney Disease

Tanjala S. Purnell, PhD, MPH

It is well-known that predialysis nephrology care is linked to better survival among patients with end-stage kidney disease, but the demographical disparities have not fully been explored.

A team, led by Tanjala S. Purnell, PhD, MPH, Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, examined national trends in racial and ethnic disparities in receipt of predialysis nephrology care at least 1 year prior to dialysis initiation in the US from 2005-2015.

In the national registry data multiple cross-sectional study, the investigators assessed the data over more than 1 million adults in the US Renal Data System who initiated maintenance dialysis treatment. The mean age of the patient population was 62.4 years old and 310,743 patients received at least 12 months of predialysis nephrology care.

The researchers used multivariable logistic regression models to examine national trends in racial and ethnic disparities in receipt of predialysis nephrology care with adjustments for potential confounders.

The investigators sought main outcomes and measures of the receipt of at least 12 months of predialysis nephrology care as determined by clinician-based documentation on the End Stage Renal Disease Medical Evidence Report Form CMS 2728.

In 2005-2007, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults, when compared with White adults.

On the other hand, in 2015-2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults, when compared with White adults.

“In this cross-sectional study of more than 1 million US adults with end-stage kidney disease, racial and ethnic disparities in predialysis nephrology care did not substantially improve from 2005 to 2015,” the authors wrote. “Study findings suggest that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed.”

In a separate study earlier this year, researchers identified trends in the prevalence of chronic kidney disease for all major sociodemographic groups in recent years.

In the repeated cross-sectional study, the investigators analyzed data from the National Health and Nutrition Examination Surveys for 1988-1994 and every 2 years from 1999-2016 on 54,554 individuals at least 20 years old with information on race and ethnicity, socioeconomic status, and serum creatinine levels.

The age-, sex-, and race/ethnicity-adjusted overall prevalence of stage 3 and 4 chronic kidney disease increased from 3.9% in the 1988-1994 time period to 5.2% in the 2003-2004 (difference, 1.3%; 95% CI, 0.9%-1.7%; P <0.001 for change).

This remained relatively stable after 2004 at 5.1% in 2015-2016 (difference, −0.1%; 95% CI, −0.7% to 0.4%; P = 0.61 for change). The trend in adjusted disease prevalence overall differed substantially based on race/ethnicity (P = 0.009 for interaction).

This is especially true for non-Hispanic white and non-Hispanic black people, where the chronic kidney disease increased between 1988-1994 and 2003-2004 and remained stable thereafter.

The study, “National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015,” was published online in JAMA Network Open.