Dialysis Patients May Face Care Disparities

Led by Marc Turenne, PhD, researchers conducted an analysis designed to aid in understanding disparities in quality of care for patients on dialysis with an eye toward informing priorities for quality improvement as well as suggesting approaches for achieving greater health equity. The researchers also sought to determine whether disparities have been improving or worsening in recent years and whether there are geographic variations in disparities.

Results of the analysis were reported during a virtual poster session at ASN Kidney Week 2021. The poster was titled Disparities in Quality of Care for Dialysis Patients.

The analysis included data from Medicare and CROWNWeb to evaluate disparities based on race, ethnicity, dual eligibility, and rural-urban location. Using criteria developed by the Agency for Healthcare Research and Quality, the researchers identified disparities in 2019 based on a statistically significant regression-adjusted difference in a quality indicator and at least a 10% relative difference between groups. Generalized linear models were estimated using clustering for patients and adjustments for age, sex, cause of end-stage kidney disease (ESKD), duration of ESKD, and comorbid conditions at the time of ESKD diagnosis. National trends in disparities from 2015 to 2020 and variations in disparities by ESKD network in 2019 were examined.

The analysis examined 16 quality indicators, including use of arteriovenous fistulas, long-term catheter use, dialysis-related infection hospital admission, outpatient emergency department visits, mortality, dialysis access-related infection hospital admission, all-cause hospital admissions, and hospice use at death. Disparities involving racial minorities and dual eligible beneficiaries accounted for 13 of the 16 measured disparities. The disparities persisted over time and were found in most ESKD networks.

In summary, the authors said, “There are ongoing racial, socioeconomic, and rural-urban disparities among dialysis patients in a range of quality indicators. There may be valuable opportunities for quality initiatives in ESKD to improve health equity.”

Source: Turenne M, Cogan CM, Pearson J, Huff ED. Disparities in quality of care for dialysis patients. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2021 (Abstract PO0791), November 2021.