National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015

Abstract

This national registry study examines national trends in racial/ethnic disparities in the receipt of predialysis nephrology care at least 1 year before dialysis initiation among adults with end-stage kidney disease in the United States from 2005 to 2015.

Key Points

Question

Have racial and ethnic disparities in the receipt of at least 12 months of predialysis nephrology care narrowed during the last decade in the United States?

Findings

In this cross-sectional study of national registry data for 1 000 390 US adults with end-stage kidney disease, receipt of at least 12 months of predialysis nephrology care increased overall from 2005 to 2015; however, disparities did not improve. In 2005 to 2007, compared with White adults, the odds of receiving predialysis nephrology care was lower by 18% among Black adults, 33% among Hispanic adults, and 16% among Asian adults; similar differences were observed in 2014 to 2015 (24% among Black adults, 39% among Hispanic adults, and 10% among Asian adults).

Meaning

This national study found that racial and ethnic disparities in receipt of at least 12 months of predialysis nephrology care did not improve from 2005 to 2015, suggesting that national strategies to address these disparities are needed.

Abstract

Importance

Predialysis nephrology care is associated with better survival among patients with end-stage kidney disease.

Objective

To examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care at least 1 year before dialysis initiation in the United States from 2005 to 2015.

Design, Setting, and Participants

This national registry study assessed US registry data of 1 000 390 adults in the US Renal Data System who initiated maintenance dialysis treatment from January 1, 2005, to December 31, 2015, in multiple cross-sectional analyses. Multivariable logistic regression models were used to examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care with adjustments for potential confounders. Data were analyzed April 17, 2020.

Exposure

Race/ethnicity of the patients.

Main Outcomes and Measures

Receipt of at least 12 months of predialysis nephrology care as determined by clinician-based documentation on the End Stage Renal Disease Medical Evidence Report Form CMS 2728.

Results

Among 1 000 390 adults (57.2% male; 54.6% White, 27.8% Black, 14.0% Hispanic, and 3.6% Asian; mean [SD] age, 62.4 [15.6] years) who initiated maintenance dialysis in the United States from 2005 to 2015, 310 743 (31.1%) received at least 12 months of predialysis nephrology care. In 2005 to 2007, compared with White adults, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among Black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults; in 2014 to 2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults.

Conclusions and Relevance

In this cross-sectional study of more than 1 million US adults with end-stage kidney disease, racial and ethnic disparities in predialysis nephrology care did not substantially improve from 2005 to 2015. Study findings suggest that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed.