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J Natl Med Assoc. 2002 August; 94(8 Suppl): 45S–54S.
PMCID: PMC2594174

Racial disparities in renal replacement therapy.

Abstract

Renal replacement therapy (RRT)--encompassing hemodialysis, peritoneal dialysis, and kidney transplantation--provides life-sustaining treatment for the expanding end-stage renal disease (ESRD) population. There is an excess burden of ESRD in African-American, Hispanic, Native Americans, and Asian/Pacific Islanders. Moreover, there is mounting evidence to suggest that significant racial and ethnic disparities exist in RRT--including referral and initiation of dialysis, adequacy of dialysis, and anemia management--with non-white patients usually at a disadvantage. In addition, there are cultural and sociodemographic differences that lead to racial variation in the choice of ESRD modality. Lastly, in certain ethnic ESRD populations, there are a series of complex issues, from biologic to socioeconomic, which limit kidney transplantation--the treatment of choice. Despite these inequalities, which are often associated with negative outcomes, these non-white groups have better hemodialysis survival rates than white patients. It is essential to develop strategies to address the disparities in ESRD treatment among minority groups in order to minimize the differences in RRT provision and identify the factors that confer improved dialysis survival-thus improving care for all Americans with kidney disease.

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Selected References

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  • Xue JL, Ma JZ, Louis TA, Collins AJ. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol. 2001 Dec;12(12):2753–2758. [PubMed]
  • Reddan DN, Szczech LA, Klassen PS, Owen WF., Jr Racial inequity in America's ESRD program. Semin Dial. 2000 Nov-Dec;13(6):399–403. [PubMed]
  • Roubicek C, Brunet P, Huiart L, Thirion X, Leonetti F, Dussol B, Jaber K, Andrieu D, Ramananarivo P, Berland Y. Timing of nephrology referral: influence on mortality and morbidity. Am J Kidney Dis. 2000 Jul;36(1):35–41. [PubMed]
  • Ifudu O, Dawood M, Iofel Y, Valcourt JS, Friedman EA. Delayed referral of black, Hispanic, and older patients with chronic renal failure. Am J Kidney Dis. 1999 Apr;33(4):728–733. [PubMed]
  • Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ. Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol. 2000 Dec;11(12):2351–2357. [PubMed]
  • Winkelmayer WC, Glynn RJ, Levin R, Owen WF, Jr, Avorn J. Determinants of delayed nephrologist referral in patients with chronic kidney disease. Am J Kidney Dis. 2001 Dec;38(6):1178–1184. [PubMed]
  • Freeman HE, Corey CR. Insurance status and access to health services among poor persons. Health Serv Res. 1993 Dec;28(5):531–541. [PMC free article] [PubMed]
  • Mort EA, Edwards JN, Emmons DW, Convery K, Blumenthal D. Physician response to patient insurance status in ambulatory care clinical decision-making. Implications for quality of care. Med Care. 1996 Aug;34(8):783–797. [PubMed]
  • Horner RD, Oddone EZ, Matchar DB. Theories explaining racial differences in the utilization of diagnostic and therapeutic procedures for cerebrovascular disease. Milbank Q. 1995;73(3):443–462. [PubMed]
  • Levy DR. White doctors and black patients: influence of race on the doctor-patient relationship. Pediatrics. 1985 Apr;75(4):639–643. [PubMed]
  • Schmidt RJ, Domico JR, Sorkin MI, Hobbs G. Early referral and its impact on emergent first dialyses, health care costs, and outcome. Am J Kidney Dis. 1998 Aug;32(2):278–283. [PubMed]
  • Stack Austin G. Determinants of modality selection among incident US dialysis patients: results from a national study. J Am Soc Nephrol. 2002 May;13(5):1279–1287. [PubMed]
  • Winkelmayer WC, Glynn RJ, Levin R, Owen W, Jr, Avorn J. Late referral and modality choice in end-stage renal disease. Kidney Int. 2001 Oct;60(4):1547–1554. [PubMed]
  • Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998 May;9(5):869–876. [PubMed]
  • Astor BC, Eustace JA, Powe NR, Klag MJ, Sadler JH, Fink NE, Coresh J. Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. Am J Kidney Dis. 2001 Sep;38(3):494–501. [PubMed]
  • Stehman-Breen CO, Sherrard DJ, Gillen D, Caps M. Determinants of type and timing of initial permanent hemodialysis vascular access. Kidney Int. 2000 Feb;57(2):639–645. [PubMed]
  • Arora P, Obrador GT, Ruthazer R, Kausz AT, Meyer KB, Jenuleson CS, Pereira BJ. Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol. 1999 Jun;10(6):1281–1286. [PubMed]
  • Owen WF, Jr, Chertow GM, Lazarus JM, Lowrie EG. Dose of hemodialysis and survival: differences by race and sex. JAMA. 1998 Nov 25;280(20):1764–1768. [PubMed]
  • Gokal R. Long term peritoneal dialysis--is it a reality? J Nephrol. 1999 Nov-Dec;12(6):362–370. [PubMed]
  • Van Biesen W, Vanholder RC, Veys N, Dhondt A, Lameire NH. An evaluation of an integrative care approach for end-stage renal disease patients. J Am Soc Nephrol. 2000 Jan;11(1):116–125. [PubMed]
  • Heaf James G, Løkkegaard Hans, Madsen Melvin. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant. 2002 Jan;17(1):112–117. [PubMed]
  • Passadakis P, Thodis E, Vargemezis V, Oreopoulos D. Long-term survival with peritoneal dialysis in ESRD due to diabetes. Clin Nephrol. 2001 Oct;56(4):257–270. [PubMed]
  • Barker-Cummings C, McClellan W, Soucie JM, Krisher J. Ethnic differences in the use of peritoneal dialysis as initial treatment for end-stage renal disease. JAMA. 1995 Dec 20;274(23):1858–1862. [PubMed]
  • Frankenfield DL, Rocco MV, Frederick PR, Pugh J, McClellan WM, Owen WF., Jr Racial/ethnic analysis of selected intermediate outcomes for hemodialysis patients: results from the 1997 ESRD Core Indicators Project. Am J Kidney Dis. 1999 Oct;34(4):721–730. [PubMed]
  • Saade M, Joglar F. Chronic peritoneal dialysis: seven-year experience in a large Hispanic program. Perit Dial Int. 1995;15(1):37–41. [PubMed]
  • Nolph KD, Cutler SJ, Steinberg SM, Novak JW, Hirschman GH. Factors associated with morbidity and mortality among patients on CAPD. ASAIO Trans. 1987 Apr-Jun;33(2):57–65. [PubMed]
  • Collins AJ, Li S, St Peter W, Ebben J, Roberts T, Ma JZ, Manning W. Death, hospitalization, and economic associations among incident hemodialysis patients with hematocrit values of 36 to 39%. J Am Soc Nephrol. 2001 Nov;12(11):2465–2473. [PubMed]
  • Coladonato Joseph A, Frankenfield Diane L, Reddan Donal N, Klassen Preston S, Szczech Lynda A, Johnson Curtis A, Owen William F., Jr Trends in anemia management among US hemodialysis patients. J Am Soc Nephrol. 2002 May;13(5):1288–1295. [PubMed]
  • Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993 Sep 15;270(11):1339–1343. [PubMed]
  • Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec 2;341(23):1725–1730. [PubMed]
  • Danielson BL, LaPree AJ, Odland MD, Steffens EK. Attitudes and beliefs concerning organ donation among Native Americans in the upper Midwest. J Transpl Coord. 1998 Sep;8(3):153–156. [PubMed]
  • Epstein AM, Ayanian JZ, Keogh JH, Noonan SJ, Armistead N, Cleary PD, Weissman JS, David-Kasdan JA, Carlson D, Fuller J, et al. Racial disparities in access to renal transplantation--clinically appropriate or due to underuse or overuse? N Engl J Med. 2000 Nov 23;343(21):1537–1537. [PubMed]
  • Bleyer AJ, Tell GS, Evans GW, Ettinger WH, Jr, Burkart JM. Survival of patients undergoing renal replacement therapy in one center with special emphasis on racial differences. Am J Kidney Dis. 1996 Jul;28(1):72–81. [PubMed]
  • Alexander GC, Sehgal AR. Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA. 1998 Oct 7;280(13):1148–1152. [PubMed]
  • Eggers PW. Racial differences in access to kidney transplantation. Health Care Financ Rev. 1995 Winter;17(2):89–103. [PubMed]
  • Gaylin DS, Held PJ, Port FK, Hunsicker LG, Wolfe RA, Kahan BD, Jones CA, Agodoa LY. The impact of comorbid and sociodemographic factors on access to renal transplantation. JAMA. 1993 Feb 3;269(5):603–608. [PubMed]
  • Soucie JM, Neylan JF, McClellan W. Race and sex differences in the identification of candidates for renal transplantation. Am J Kidney Dis. 1992 May;19(5):414–419. [PubMed]
  • Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients' preferences on racial differences in access to renal transplantation. N Engl J Med. 1999 Nov 25;341(22):1661–1669. [PubMed]
  • Ozminkowski RJ, White AJ, Hassol A, Murphy M. Minimizing racial disparity regarding receipt of a cadaver kidney transplant. Am J Kidney Dis. 1997 Dec;30(6):749–759. [PubMed]
  • Winkleby MA, Kraemer HC, Ahn DK, Varady AN. Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1998 Jul 22;280(4):356–362. [PubMed]
  • Sanfilippo FP, Vaughn WK, Peters TG, Shield CF, 3rd, Adams PL, Lorber MI, Williams GM. Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States. JAMA. 1992 Jan 8;267(2):247–252. [PubMed]
  • Hata Y, Cecka JM, Takemoto S, Ozawa M, Cho YW, Terasaki PI. Effects of changes in the criteria for nationally shared kidney transplants for HLA-matched patients. Transplantation. 1998 Jan 27;65(2):208–212. [PubMed]
  • Ellison MD, Breen TJ, Guo TG, Cunningham PR, Daily OP. Blacks and whites on the UNOS renal waiting list: waiting times and patient demographics compared. Transplant Proc. 1993 Aug;25(4):2462–2466. [PubMed]
  • Isaacs RB, Lobo PI, Nock SL, Hanson JA, Ojo AO, Pruett TL. Racial disparities in access to simultaneous pancreas-kidney transplantation in the United States. Am J Kidney Dis. 2000 Sep;36(3):526–533. [PubMed]
  • Isaacs RB, Nock SL, Spencer CE, Connors AF, Jr, Wang XQ, Sawyer R, Lobo PI. Racial disparities in renal transplant outcomes. Am J Kidney Dis. 1999 Oct;34(4):706–712. [PubMed]
  • Opelz G, Wujciak T, Schwarz V, Back D, Mytilineos J, Scherer S. Collaborative Transplant Study analysis of graft survival in blacks. Transplant Proc. 1993 Aug;25(4):2443–2445. [PubMed]
  • Didlake RH, Dreyfus K, Kerman RH, Van Buren CT, Kahan BD. Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal transplants. Transplant Proc. 1988 Jun;20(3 Suppl 3):63–69. [PubMed]
  • Siegal BR, Greenstein SM. Postrenal transplant compliance from the perspective of African-Americans, Hispanic-Americans, and Anglo-Americans. Adv Ren Replace Ther. 1997 Jan;4(1):46–54. [PubMed]
  • Owen WF., Jr Racial differences in incidence, outcome, and quality of life for African-Americans on hemodialysis. Blood Purif. 1996;14(4):278–285. [PubMed]
  • Price DA, Owen WF., Jr African-Americans on maintenance dialysis: a review of racial differences in incidence, treatment, and survival. Adv Ren Replace Ther. 1997 Jan;4(1):3–12. [PubMed]
  • Satcher D. Does race interfere with the doctor-patient relationship? JAMA. 1973 Mar 26;223(13):1498–1499. [PubMed]
  • Obrador GT, Pereira BJ. Early referral to the nephrologist and timely initiation of renal replacement therapy: a paradigm shift in the management of patients with chronic renal failure. Am J Kidney Dis. 1998 Mar;31(3):398–417. [PubMed]

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