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

Abstract

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.