Racial disparities exist in end-of-life care for US dialysis patients

April 11, 2013

At the end of life, black patients with kidney failure receiving chronic dialysis are less likely to be referred to hospice and to discontinue dialysis compared with white patients, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). Racial differences in care are especially pronounced in parts of the country that spend the most on end-of-life care. Efforts are needed to better understand why there are such large racial differences in end-of-life care and to ensure that such care reflects dialysis patients' goals and preferences.

There are known racial differences in aspects of kidney health such as access to kidney transplantation and pre-dialysis kidney care, and health and survival during kidney disease and after . Racial differences in patterns of end-of-life care have generally received much less attention, although studies indicate that black patients with are less likely to be referred to hospice, less likely to discontinue dialysis, and more likely to receive intensive interventions such as ICU admission at the very end of life.

Most prior studies describing racial differences in patterns of end-of-life care have not examined whether the magnitude of these differences is uniform across different regions of the country. To investigate, Bernadette Thomas, MD (University of Washington, in Seattle) and her colleagues examined data from the United States Renal Data System on 101,331 black and white adult patients who initiated or received a between 2005 and 2008 and died before October 1, 2009. The investigators also analyzed regional healthcare spending patterns from the Dartmouth Atlas of Healthcare.

Similar to other studies, the researchers found that there were large racial differences in rates of hospice referral and dialysis discontinuation. However, when black and white patients were examined separately, the investigators also observed large differences in the frequency of hospice referral and dialysis discontinuation between high and low spending regions. "Although large racial differences in dialysis discontinuation and hospice referral were present in all regions, these differences were most pronounced in the highest spending regions," said Dr. Thomas.

Explore further: Racial inequalities exist for kids with kidney disease

More information: The article, entitled "Geographic Variation in Black-White Differences in End-of-Life Care for Patients with End-stage Renal Disease," will appear online on April 11, 2013, doi: 10.2215/CJN.06780712

Related Stories

Racial inequalities exist for kids with kidney disease

November 10, 2011
Among children with kidney disease, certain races are less likely to get kidney transplants and are more likely to die than other races, according to two studies from Emory University that were presented during the American ...

Hispanics live longest, whites shortest among dialysis patients

March 28, 2013
Among kidney failure patients on dialysis, Hispanics tend to live the longest and Whites the shortest, with Blacks' survival time in between these two, according to a study appearing in an upcoming issue of the Clinical Journal ...

Race, insurance status related to likelihood of being assessed for kidney transplantation

July 26, 2012
Young black patients and patients without private health insurance are less likely to be assessed for a kidney transplant when they start dialysis, according to a study appearing in an upcoming issue of the Clinical Journal ...

Younger black patients undergoing dialysis have higher risk of death compared to white patients

August 9, 2011
Even though overall black patients have a lower risk of death while receiving dialysis than white patients, this applies primarily to older adults, as black patients younger than 50 years of age have a significantly higher ...

Race, geographic location may affect care of patients with kidney disease

March 14, 2013
Race and geographic area play important roles in determining whether a patient with chronic kidney disease (CKD) receives optimal care before developing kidney failure, according to a study appearing in an upcoming issue ...

Recommended for you

Google searches can be used to track dengue in underdeveloped countries

July 20, 2017
An analytical tool that combines Google search data with government-provided clinical data can quickly and accurately track dengue fever in less-developed countries, according to new research published in PLOS Computational ...

MRSA emerged years before methicillin was even discovered

July 19, 2017
Methicillin resistant Staphylococcus aureus (MRSA) emerged long before the introduction of the antibiotic methicillin into clinical practice, according to a study published in the open access journal Genome Biology. It was ...

New test distinguishes Zika from similar viral infections

July 18, 2017
A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology ...

'Superbugs' study reveals complex picture of E. coli bloodstream infections

July 18, 2017
The first large-scale genetic study of Escherichia coli (E. coli) cultured from patients with bloodstream infections in England showed that drug resistant 'superbugs' are not always out-competing other strains. Research by ...

Ebola virus can persist in monkeys that survived disease, even after symptoms disappear

July 17, 2017
Ebola virus infection can be detected in rhesus monkeys that survive the disease and no longer show symptoms, according to research published by Army scientists in today's online edition of the journal Nature Microbiology. ...

Mountain gorillas have herpes virus similar to that found in humans

July 13, 2017
Scientists from the University of California, Davis, have detected a herpes virus in wild mountain gorillas that is very similar to the Epstein-Barr virus in humans, according to a study published today in the journal Scientific ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.