Racial and social disparities in the access to automated peritoneal dialysis - results of a national PD cohort

Roberto Pecoits-Filho,Adam Kirk,Thyago Proença De Moraes,Silvia Carreira Ribeiro,Arthur Pille,Pasqual Barretti,Sandro Scolari Filho,Ricardo Sprenger Falavinha,Ana Elizabeth Figueiredo,Helder Sebastião Da Silva

doi:10.1038/s41598-017-05544-1

Abstract

The prevalence of patients on automated peritoneal dialysis (APD) is increasing worldwide and may be guided by clinical characteristics, financial issues and patient option. Whether socioeconomic factors at the patient level may influence the decision for the initial peritoneal dialysis (PD) modality is unknown. This is a prospective cohort study. The primary outcome of interest was the probability to start PD on APD. The inclusion criteria were adult patients incident in PD. Exclusion criteria were missing data for either race or initial PD modality. We used a mixed-model analysis clustering patients according to their PD center and region of the country. We included 3,901 patients of which 1,819 (46.6%) had APD as their first modality. We found a significant disparity for race and educational level with African American patients less likely to start on APD (Odds ratio 0.74 CI95% 0.58–0.94) compared to Whites whilst those with greater educational levels were more likely to start on APD (Odds ratio 3.70, CI95% 2.25–6.09) compared to illiterate patients. Limiting the use of APD in disadvantaged population may be unethical. Demographics and socioeconomic status should not be necessarily part of the decision-making process of PD modality choice.

Highlights

The choice of the initial renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has been in discussion for decades and is considered to be dependent on clinical factors and related to nonclinical variables such as demographic characteristics, socioeconomic status, and race[1,2,3,4,5]
According to recent data published by Mehrotra et al based in large American dialysis cohort, Blacks and Hispanics with ESRD were less likely to start on a home dialysis and even receive kidney transplantation[6]
Such differences in the offering of home dialysis were first reported in the US more than a decade ago[5], a survey with 271 US nephrologist reported that race was not associated with peritoneal dialysis (PD) utilization, even after controlling for demographic and clinical characteristics[7]

Summary

Introduction

The choice of the initial renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has been in discussion for decades and is considered to be dependent on clinical factors and related to nonclinical variables such as demographic characteristics, socioeconomic status, and race[1,2,3,4,5]. According to recent data published by Mehrotra et al based in large American dialysis cohort, Blacks and Hispanics with ESRD were less likely to start on a home dialysis and even receive kidney transplantation[6]. Such differences in the offering of home dialysis were first reported in the US more than a decade ago[5], a survey with 271 US nephrologist reported that race was not associated with PD utilization, even after controlling for demographic and clinical characteristics[7]. The aim of this study was to investigate the impact of race and social status in the initial modality of PD in a large PD cohort

Objectives

Methods

Results

Conclusion