Racial/Ethnic Differences in Dialysis Discontinuation and Survival After Hospitalization for Serious Conditions Among Patients on Maintenance Dialysis

Overview

Journal J Am Soc Nephrol

Specialty Nephrology

Date 2019 Dec 15

PMID 31836625

Citations 7

Authors

Abdulkareem Agunbiade

Abhijit Dasgupta

Michael M Ward

Affiliations

Soon will be listed here.

Abstract

Background: Racial and ethnic minorities on dialysis survive longer than whites, and are less likely to discontinue dialysis. Both differences have been attributed by some clinicians to better health among minorities on dialysis.

Methods: To test if racial and ethnic differences in dialysis discontinuation reflected better health, we conducted a retrospective cohort study of survival and dialysis discontinuation among patients on maintenance dialysis in the US Renal Data System after hospitalization for either stroke (=60,734), lung cancer (=4100), dementia (=40,084), or failure to thrive (=42,950) between 2003 and 2014. We examined the frequency of discontinuation of dialysis and used simulations to estimate survival in minorities relative to whites if minorities had the same pattern of dialysis discontinuation as whites.

Results: Blacks, Hispanics, and Asians had substantially lower frequencies of dialysis discontinuation than whites in each hospitalization cohort. Observed risks of mortality were also lower for blacks, Hispanics, and Asians. In simulations that assigned discontinuation patterns similar to those found among whites across racial and ethnic groups, differences in survival were markedly attenuated and hazard ratios approached 1.0. Survival and dialysis discontinuation frequencies among American Indians and Alaska Natives were close to those of whites.

Conclusions: Racial and ethnic differences in dialysis discontinuation were present among patients hospitalized with similar health events. Among these patients, survival differences between racial and ethnic minorities and whites were largely attributable to differences in the frequency of discontinuation of dialysis.

Citing Articles

A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S.

Diaz M, Guarena L, Garcia B, Alarcon-Ruiz C, Seal S, Rubinos C Lancet Reg Health Am. 2024; 38:100873.

PMID: 39262429 PMC: 11387358. DOI: 10.1016/j.lana.2024.100873.

A review of supportive care for older people with advanced chronic kidney disease.

FitzGerald T, Joosten H, van Buren M, Vinen K, Brown E Clin Kidney J. 2023; 16(4):635-646.

PMID: 37007693 PMC: 10061438. DOI: 10.1093/ckj/sfac256.

Waiting-List and early posttransplant prognosis among ethnoracial groups: Data from the organ procurement and transplantation network.

Wu Y, Lv K, Hao X, Lv C, Lai W, Xia X Front Surg. 2023; 10:1045363.

PMID: 36793312 PMC: 9923172. DOI: 10.3389/fsurg.2023.1045363.

Racial Disparities in Health Beliefs and Advance Care Planning Among Patients Receiving Maintenance Dialysis.

Saeed F, Ladwig S, Allen R, Eneanya N, Kurella Tamura M, Fiscella K J Pain Symptom Manage. 2022; 65(4):318-325.

PMID: 36521766 PMC: 10103744. DOI: 10.1016/j.jpainsymman.2022.12.002.

Mortality Trends After Transfer From Peritoneal Dialysis to Hemodialysis.

Nadeau-Fredette A, Sukul N, Lambie M, Perl J, Davies S, Johnson D Kidney Int Rep. 2022; 7(5):1062-1073.

PMID: 35570995 PMC: 9091783. DOI: 10.1016/j.ekir.2022.02.016.

References

Knight E, Ofsthun N, Teng M, Lazarus J, Curhan G . The association between mental health, physical function, and hemodialysis mortality. Kidney Int. 2003; 63(5):1843-51. DOI: 10.1046/j.1523-1755.2003.00931.x. View

Tell G, Mittelmark M, Hylander B, Shumaker S, Russell G, Burkart J . Social support and health-related quality of life in black and white dialysis patients. ANNA J. 1995; 22(3):301-8; discussion 309-10. View

Liu J, Huang Z, Gilbertson D, Foley R, Collins A . An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int. 2009; 77(2):141-51. DOI: 10.1038/ki.2009.413. View

Thomas B, Rodriguez R, Boyko E, Robinson-Cohen C, Fitzpatrick A, OHare A . Geographic variation in black-white differences in end-of-life care for patients with ESRD. Clin J Am Soc Nephrol. 2013; 8(7):1171-8. PMC: 3700690. DOI: 10.2215/CJN.06780712. View

Murtagh F, Cohen L, Germain M . Dialysis discontinuation: quo vadis?. Adv Chronic Kidney Dis. 2007; 14(4):379-401. DOI: 10.1053/j.ackd.2007.07.008. View

Hussain J, Flemming K, Murtagh F, Johnson M . Patient and health care professional decision-making to commence and withdraw from renal dialysis: a systematic review of qualitative research. Clin J Am Soc Nephrol. 2015; 10(7):1201-15. PMC: 4491298. DOI: 10.2215/CJN.11091114. View

Levin J, Taylor R, Chatters L . Race and gender differences in religiosity among older adults: findings from four national surveys. J Gerontol. 1994; 49(3):S137-45. DOI: 10.1093/geronj/49.3.s137. View

Bowman K, Singer P . Chinese seniors' perspectives on end-of-life decisions. Soc Sci Med. 2001; 53(4):455-64. DOI: 10.1016/s0277-9536(00)00348-8. View

Blackhall L, FRANK G, Murphy S, Michel V, Palmer J, Azen S . Ethnicity and attitudes towards life sustaining technology. Soc Sci Med. 1999; 48(12):1779-89. DOI: 10.1016/s0277-9536(99)00077-5. View

10.

Cohen L, Germain M, Poppel D, Woods A, Pekow P, Kjellstrand C . Dying well after discontinuing the life-support treatment of dialysis. Arch Intern Med. 2000; 160(16):2513-8. DOI: 10.1001/archinte.160.16.2513. View

11.

Lopes A, Bragg-Gresham J, Satayathum S, McCullough K, Pifer T, Goodkin D . Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2003; 41(3):605-15. DOI: 10.1053/ajkd.2003.50122. View

12.

Leaf D, Goldfarb D . Interpretation and review of health-related quality of life data in CKD patients receiving treatment for anemia. Kidney Int. 2008; 75(1):15-24. DOI: 10.1038/ki.2008.414. View

13.

Robinson B, Joffe M, Pisoni R, Port F, Feldman H . Revisiting survival differences by race and ethnicity among hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study. J Am Soc Nephrol. 2006; 17(10):2910-8. DOI: 10.1681/ASN.2005101078. View

14.

Kurella Tamura M, Goldstein M, Perez-Stable E . Preferences for dialysis withdrawal and engagement in advance care planning within a diverse sample of dialysis patients. Nephrol Dial Transplant. 2009; 25(1):237-42. PMC: 2910327. DOI: 10.1093/ndt/gfp430. View

15.

Balboni T, Vanderwerker L, Block S, Paulk M, Lathan C, Peteet J . Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007; 25(5):555-60. PMC: 2515558. DOI: 10.1200/JCO.2006.07.9046. View

16.

Chen J, Thorsteinsdottir B, Vaughan L, Feely M, Albright R, Onuigbo M . End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy. Clin J Am Soc Nephrol. 2018; 13(8):1172-1179. PMC: 6086702. DOI: 10.2215/CJN.00590118. View

17.

Neu S, Kjellstrand C . Stopping long-term dialysis. An empirical study of withdrawal of life-supporting treatment. N Engl J Med. 1986; 314(1):14-20. DOI: 10.1056/NEJM198601023140103. View

18.

Streja E, Kovesdy C, Molnar M, Norris K, Greenland S, Nissenson A . Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients. Am J Kidney Dis. 2011; 57(6):883-93. PMC: 3081903. DOI: 10.1053/j.ajkd.2010.10.050. View

19.

Smith A, Sudore R, Perez-Stable E . Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA. 2009; 301(10):1047-57, E1. PMC: 2782583. DOI: 10.1001/jama.2009.308. View

20.

Siegal B, Calsyn R, Cuddihee R . The relationship of social support to psychological adjustment in end-stage renal disease patients. J Chronic Dis. 1987; 40(4):337-44. DOI: 10.1016/0021-9681(87)90049-x. View