Racial/Ethnic Differences in Dialysis Discontinuation and Survival after Hospitalization for Serious Conditions among Patients on Maintenance Dialysis

J Am Soc Nephrol. 2020 Jan;31(1):149-160. doi: 10.1681/ASN.2019020122. Epub 2019 Dec 13.

Abstract

Background: Racial and ethnic minorities on dialysis survive longer than whites, and are less likely to discontinue dialysis. Both differences have been attributed by some clinicians to better health among minorities on dialysis.

Methods: To test if racial and ethnic differences in dialysis discontinuation reflected better health, we conducted a retrospective cohort study of survival and dialysis discontinuation among patients on maintenance dialysis in the US Renal Data System after hospitalization for either stroke (n=60,734), lung cancer (n=4100), dementia (n=40,084), or failure to thrive (n=42,950) between 2003 and 2014. We examined the frequency of discontinuation of dialysis and used simulations to estimate survival in minorities relative to whites if minorities had the same pattern of dialysis discontinuation as whites.

Results: Blacks, Hispanics, and Asians had substantially lower frequencies of dialysis discontinuation than whites in each hospitalization cohort. Observed risks of mortality were also lower for blacks, Hispanics, and Asians. In simulations that assigned discontinuation patterns similar to those found among whites across racial and ethnic groups, differences in survival were markedly attenuated and hazard ratios approached 1.0. Survival and dialysis discontinuation frequencies among American Indians and Alaska Natives were close to those of whites.

Conclusions: Racial and ethnic differences in dialysis discontinuation were present among patients hospitalized with similar health events. Among these patients, survival differences between racial and ethnic minorities and whites were largely attributable to differences in the frequency of discontinuation of dialysis.

Keywords: ESRD; ethnicity; survival.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Asian Americans / statistics & numerical data*
  • Cohort Studies
  • Female
  • Hispanic or Latino / statistics & numerical data*
  • Hospitalization*
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Minority Groups
  • Racial Groups
  • Renal Dialysis / statistics & numerical data*
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Whites / statistics & numerical data*
  • Withholding Treatment / statistics & numerical data*
  • Young Adult