Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States

Gao, Yan; Shen, Jenny I.; Harford, R J; Yu, Wei; Nee, Robert; Clark, Mary Jo; Flaque, Jose; Colón, José E.; Torre, Francisco; Rodriguez, Ylene; Georges, Jane M.; Agodoa, Lawrence Y.; Norris, Keith C.

doi:10.2215/cjn.03920319

Cited by 13 publications

(7 citation statements)

References 25 publications

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“… 45 In the United States, crude mortality rates are higher still at 15 to 29 deaths/100 person-years with high-flux membranes. 46 Collectively, these data suggest no obvious excess mortality with MCO dialysis, but confirmatory trials are needed. Such studies could provide additional information on other SAEs, which also appear to be rare.…”

Section: Discussionmentioning

confidence: 93%

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Kandi

Brignardello‐Petersen

Couban

et al. 2022

Can J Kidney Health Dis

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Background: A novel medium cut-off (MCO) dialyzer (Theranova, Baxter Healthcare, Deerfield, IL, USA) enhances large middle molecule clearance while retaining selectivity for molecules >45 000 Da. Objective: We undertook a systematic review and meta-analysis evaluating clinical outcomes with MCO vs high-flux membranes. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science through July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults receiving maintenance hemodialysis. Pairs of reviewers performed study selection, data extraction, and risk of bias assessment in duplicate. We conducted random-effects pairwise meta-analyses to pool results across studies and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence certainty. Results: We identified 22 eligible studies (6 RS, 16 NRS; N = 1811 patients; patient-years = 1546). The MCO dialyzer improved (estimate; 95% confidence interval [CI]; certainty rating) quality of life (mean difference [MD] = 16.7/100 points; 6.9 to 26.4; moderate), Kidney Disease Quality of Life Instrument (KDQOL) subscales—burden (MD = 4.0; 1.1 to 6.9; moderate) and effects (MD = 5.4; 3.2 to 7.6; moderate), pruritus (MD = −4.4; −7.1 to −1.7; moderate), recovery time (MD = −420 minutes; −541 to −299; high), and restless legs syndrome (odds ratio = 0.39; 0.29 to 0.53; moderate). There was little to no difference in all-cause mortality (risk difference = −0.4%; −2.8 to 2.1; moderate) and serious adverse events (rate ratio = 0.63; 0.38 to 1.04; low). MCO dialysis reduced hospitalization (rate ratio = 0.48; 0.27 to 0.84; low), infection (rate ratio = 0.38; 0.17 to 0.85; moderate), hospitalization days (MD = −1.5 days; 95% CI, −2.22 to −0.78; moderate), erythropoiesis resistance index (MD = −2.92 U/kg/week/g/L; 95% CI, −4.25 to −1.6; moderate) and cumulative iron use over 12 weeks (MD = −293 mg; 95% CI, −368 to −218; moderate). We found with low certainty that MCO dialysis had little to no effect on KDQOL symptoms/problem list, pain, and physical health and moderate certainty that MCO dialysis likely has no effect on the KDQOL mental health composite. Conclusions: We found with predominantly moderate certainty that the MCO dialyzer improves several patient-important outcomes with no apparent risks or harms. More definitive studies are needed to better quantify the effects of MCO membranes on mortality, hospitalization, and other rare events.

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Section: Discussionmentioning

confidence: 93%

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Kandi

Brignardello‐Petersen

Couban

et al. 2022

Can J Kidney Health Dis

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“…Regionally, patients living outside the Northeast United States had higher mortality rates after hospitalization 56 . While mortality rates by racial group were inconclusive between the United States and United States territories, 79 Black patients were less likely to receive CPR in clinics in the South and West United States 53 . Additionally, in every state but Massachusetts, Black patients were less likely to use PD than white patients 37 .…”

Section: Resultsmentioning

confidence: 99%

Health inequities in dialysis care: A scoping review

Purcell,

Schnitker,

Moore

et al. 2023

Seminars in Dialysis

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Main ProblemWe aim to look at potential gaps in current dialysis literature on inequities and explore future research that could contribute to more equitable care.MethodsFollowing guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA‐ScR), we conducted a scoping review of health inequities in dialysis. PubMed and Ovid Embase were searched in July 2022 for articles published between 2016 and 2022 that examined at least one of the following NIH defined health inequities: race/ethnicity, sex/gender, LGBTQ+ identity, underserved rural populations, education level, income, and occupation status. Frequencies of each health inequity as well as trends over time of the four most examined inequities were analyzed.ResultsIn our sample of 69 included studies, gaps were identified in LGBTQ+ identity and patient education. Inequities pertaining to race/ethnicity, sex/gender, underserved rural populations, and income were sufficiently reported. No trends between inequities investigated over time were identified.ConclusionsOur scoping review examined current literature on health inequities pertaining to dialysis and found gaps concerning LGBTQ+ and patients with lower levels of education. To help fill these gaps, and possibly alleviate additional burden to these patients, we recommend cultural competency training for providers and dialysis center staff as well as community‐based educational programs to improve dialysis patients' health literacy.

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“…In addition, the majority of Asian subgroups and NHOPI individuals in Hawaii/ Pacific Islands tended to be younger and had worse health indicators (less pre-ESKD care, lower serum albumin, higher blood urea nitrogen, and creatinine concentrations) versus those in Northern California. In a subsequent rigorous study of incident dialysis patients treated over 1995-2012, Yan et al [25] found that ESKD mortality across racial/ethnic groups differed across US territories (Puerto Rico, USA Virgin Islands, Guam, Northern Mariana Islands, and American Samoa) versus the 50 contiguous states. Notably, Asian/NHOPI patients (examined as an aggregate group) and Hispanic patients demonstrated higher death risk in the US territories, whereas similar survival across geographic location was observed among White and Black incident dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence

You,

Norris,

Kataoka-Yahiro

et al. 2023

Am J Nephrol

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Introduction: While Asians and Native Hawaiian and other Pacific Islanders (NHOPIs) have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asians and NHOPIs, we compared their ESKD outcomes based on residence in the Mainland US vs. Hawaii/Pacific Islands (PIs). Materials and Methods: Using United States Renal Data System data, we examined the impact of geographic residence in the Mainland vs. Hawaii/PIs on race—mortality associations among incident ESKD patients transitioning to dialysis over 1/1/2000-12/31/2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. Results: Compared with White patients in the Mainland, Asians and NHOPIs in the Mainland had lower mortality: Adjusted HRs (aHRs) (95%CIs) 0.67 (0.66-0.67) and 0.72 (0.70-0.73), respectively. When examining Asians and NHOPIs in Hawaii/PIs, survival benefit was attenuated in Asians and diminished to the null in NHOPIs (ref: Mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asians and NHOPIs in the Mainland had the highest likelihood of transplantation, whereas NHOPIs and Asians in Hawaii/PIs had the lowest likelihood. Discussion/Conclusion: In the Mainland, Asians and NHOPIs had lower mortality vs. White patients, whereas in Hawaii/PIs this survival benefit was diminished in Asians and mitigated in NHOPIs. NHOPIs and Asians in Hawaii/PIs had less transplantation vs. those in the Mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asians and NHOPIs across geographic residence.

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Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States

Cited by 13 publications

References 25 publications

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis

Health inequities in dialysis care: A scoping review

Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence

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