Sex and Racial/Ethnic Differences in Home Hemodialysis Mortality

被引:1
|
作者
Shah, Silvi [1 ,5 ]
Gupta, Nupur [2 ]
Christianson, Annette L. [3 ]
Meganathan, Karthikeyan [3 ]
Leonard, Anthony C. [3 ]
Thakar, Charuhas V. [1 ,4 ]
机构
[1] Univ Cincinnati, Div Nephrol, Kidney CARE Program, Cincinnati, OH USA
[2] Indiana Univ, Div Nephrol, Indianapolis, IN USA
[3] Univ Cincinnati, Dept Environm Hlth, Cincinnati, OH USA
[4] Cincinnati VA Med Ctr, Cincinnati, OH USA
[5] Univ Cincinnati, Dept Med, Div Nephrol, 231 Albert Sabin Way,MSB6112, Cincinnati, OH 45267 USA
来源
KIDNEY360 | 2023年 / 4卷 / 02期
基金
美国国家卫生研究院;
关键词
dialysis; home hemodialysis; mortality; race; ethnicity; sex; QUALITY-OF-LIFE; DIALYSIS PATIENTS; FREQUENT HEMODIALYSIS; PRACTICE PATTERNS; RACE; SURVIVAL; OUTCOMES; DISEASE; GENDER; IMPACT;
D O I
10.34067/KID.0005712022
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Women and minorities constitute substantial portions of the prevalent population of patients with kidney failure. Little is known about sex and racial/ethnic differences in mortality among patients with kidney failure on home hemodialysis in the United States.Methods Using the United States Renal Data System, we retrospectively evaluated a cohort of 42,849 patients who started home hemodialysis between January 1, 2005, and December 31, 2015. We examined the association of sex and race/ethnicity with the outcome of all-cause mortality using adjusted Cox proportional hazard models and logistic regression models.Results In the study cohort, 40.4% were women, and 57.4% were White. Women on home hemodialysis had higher unadjusted death rates (26.9 versus 22.4 per 100 person-years) compared with men. There was no difference in adjusted all-cause mortality between men and women, but women had an 8% higher adjusted risk of all-cause mortality at 1 year after initiating home hemodialysis (odds ratio 1.08, 95% confidence interval [CI], 1.01 to 1.15). Regarding race/ethnicity, Hispanic, White, and Black patients had higher unadjusted death rates compared with Asians and Native Americans (25.1 versus 24.8 versus 23.2 versus 17.4 versus 16.6 per 100 person-years). There was no difference in adjusted all-cause mortality in Black, Hispanic, and Native Americans compared with White patients, while Asians had a lower risk of all-cause mortality than did White patients (hazard ratio, 0.81; 95% CI, 0.72 to 0.92). There was no difference in adjusted 1-year mortality for Asian, Black, Hispanic, and Native American patients compared with White patients.Conclusions Among patients undergoing home hemodialysis, women have higher 1-year mortality than men, and women and men have comparable survival on long-term follow-up after adjusting for other covariates. Compared with White patients, there was no difference in adjusted survival on long-term follow-up for Black patients, Hispanics, or Native Americans, while Asians had better survival. Our results suggest the need for population-wide strategies to overcome differences in home hemodialysis care.
引用
收藏
页码:206 / 216
页数:11
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