Usage and Health Outcomes of Home Hemodialysis vs Center Hemodialysis in Racial/Ethnic Minority Groups in the United States a Quantitative Research in 2016–2019 USRDS Using Aday-Anderson Framework and Multiple Regression Models

Abstract

Introduction

Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities.

Methods

The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016–2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations.

Results

Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546–0.592; Hispanics: OR, 0.510, 95% CI, 0.477–0.544; Asians: OR, 0.689, 95% CI, 0.619–0.766; Others: OR, 0.453, 95% CI, 0.390–0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641–0.734; White: OR, 0.670, 95% CI, 0.612–0.734; Blacks: OR, 0.717, 95% CI, 0.644–0.799; Hispanics: OR, 0.715, 95% CI, 0.575–0.889; Others: OR, 0.473, 95% CI, 0.265–0.844).

Conclusion

There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.

Keywords:

• home hemodialysis
• racial/ethnic differences
• end-stage renal disease
• health service use
• risk of death

Abbreviations

Adjusted HR, adjusted hazard ratio; adjusted OR, adjusted odds ratio; AAKH, Advancing American Kidney Health; CMS, Centers for Medicare & Medicaid Services; CI, confidence Interval; CHD, center hemodialysis; CKD, chronic kidney disease; Stage 1, Kidney Damage with Normal or High GFR. GFR: ≥90 mL/min. Kidney damage is present, but the GFR is still normal or high; Stage 2, Mild Reduction in GFR. GFR: 60-89 mL/min. There is a mild reduction in GFR, indicating kidney function is moderately reduced; Stage 3: Moderate Reduction in GFR. GFR: 30–59 mL/min. Kidney function is moderately reduced. This stage is further divided into; Stage 4, Severe Reduction in GFR. GFR: 15–29 mL/min. Kidney function is severely reduced. This stage is associated with significant risk of complications; Stage 5, Kidney Failure (End-Stage Renal Disease). GFR: <15 mL/min. Kidney function is very low, and patients may require renal replacement therapy, such as dialysis or kidney transplantation; CKF, chronic kidney failure; ESKD, end-stage kidney disease; GAO, Government Accountability Office; HD, hemodialysis; HHD, home hemodialysis; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NKF, National Kidney Foundation; NOS, Newcastle-Ottawa Scale for quality assessment; UNOS, United Network for Organ Sharing; PD, peritoneal dialysis; SEF, socioeconomic factor; SAFs, Standard Analysis Files; US, United States; USRDS, United States Renal Disease System.

Ethical Statement

This study was approved by the University of Maryland Institutional Review Board (approval no. 1850214-1). All the data accessed complied with relevant data protection and privacy regulations.

Acknowledgments

In preparing this article, we would like to express our sincere gratitude to Dr. Luisa Franzini.

As a quantitative research paper of the author’s original Ph.D. dissertations, the whole article “Home Hemodialysis Utilization and Health Outcomes Among Racial and Ethnic Minority Population” was first published by the ProQuest, LLC (789 E. Eisenhower Parkway Ann Arbor, MI 48108-3218) on October 10, 2023, in the United States, with the registration number TX 9-324-524.

Disclosure

The author reports no conflicts of interest in this work.