Racial Differences in Home Dialysis Utilization and Outcomes in Canada

Clinical journal of the American Society of Nephrology: CJASN

Emilie Trinh³ 

[1] and..;and..‡Division of Nephrology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada..*Division of Nephrology, University Health Network, Toronto, Ontario, Canada;*Division of Nephrology, University Health Network, Toronto, Ontario, Canada;†Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

关键词: ethnicity;    ethnic disparities;    home dialysis;    home hemodialysis;    patient survival;    race;    racial disparities;    technique survival;    Hemodialysis, Home;    Minority Groups;    Linear Models;    Canada;    European Continental Ancestry Group;    African Continental Ancestry Group;    peritoneal dialysis;    Asian Continental Ancestry Group;   

DOI  :  10.2215/CJN.03820417

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Data on racial disparities in home dialysis utilization and outcomes are lacking in Canada, where health care is universally available.Design, setting, participants, & measurements We studied patients starting maintenance dialysis between 1996 and 2012 in the Canadian Organ Replacement Register, stratified by race: white, Asian, black, Aboriginal, Indian subcontinent, and other. The association between race and treatment with home dialysis was examined using generalized linear models. Secondary outcomes assessed racial differences in all-cause mortality and technique failure using a Fine and Gray competing risk model.Results 66,600 patients initiated chronic dialysis between 1996 and 2012. Compared with whites (n=46,092), treatment with home dialysis was lower among Aboriginals (n=3866; adjusted relative risk, RR, 0.71; 95% confidence interval, CI, 0.66 to 0.76) and higher in Asians (n=4157; adjusted RR, 1.28; 95% CI, 1.22 to 1.35) and others (n=2170; adjusted RR, 1.12; 95% CI, 1.04 to 1.20) but similar in blacks (n=2143) and subcontinent Indians (n=2809). Black (adjusted hazard ratio, HR, 1.31; 95% CI, 1.16 to 1.48) and Aboriginal (adjusted HR, 1.19; 95% CI, 1.06 to 1.33) patients treated with peritoneal dialysis had a significantly higher adjusted risk of technique failure compared with whites, whereas Asians had a lower risk (adjusted HR, 0.89; 95% CI, 0.82 to 0.99). In patients on peritoneal dialysis, the risk of death was significantly lower in Asians (adjusted HR, 0.83; 95% CI, 0.75 to 0.92), blacks (adjusted HR, 0.71; 95% CI, 0.59 to 0.85), and others (adjusted HR, 0.79; 95% CI, 0.68 to 0.92) but higher in Aboriginals (adjusted HR, 1.16; 95% CI, 1.02 to 1.32) compared with whites. Among patients on home hemodialysis, no significant racial differences in patient and technique survival were observed, which may be limited by the low number of events among each subgroups.Conclusions With the exception of Aboriginals, all racial minority groups in Canada were as likely to be treated with home dialysis compared with whites. However, significant racial differences exist in outcomes.

【 授权许可】

CC BY