tudies are needed to uncover the layers through which structural racism influences home dialysis underuse among marginalized populations. Background Predialysis nephrology care and KRT-directed education (KDE) are essential for incident home dialysis use. However, there are substantial disparities in these care parameters among patients with advanced CKD. The effect of these disparities on home dialysis underuse has not been examined. Methods We analyzed the 2021 United States Renal Database System to identify all adult patients with kidney failure with over 6 months of predialysis Medicare coverage initiating their first-ever dialysis between 2010 and 2019. We used a mediation analysis to dissect the attributable influence of disparities in predialysis nephrology care and KDE on incident home dialysis use. In addition, we conducted sensitivity analyses using graded levels of mediators and sustained effect on home dialysis outcomes. Results We identified 464,310 Medicare recipients: 428,301 using in-center hemodialysis and 35,416 using home dialysis as their first-ever dialysis modality during the study period. Compared with non-Hispanic White patients (n=294,914), adjusted odds ratio (95% confidence intervals) for receiving predialysis nephrology care, KDE service, and incident home dialysis were 0.62 (0.61 to 0.64), 0.58 (0.52 to 0.63), and 0.76 (0.73 to 0.79), respectively, among Hispanic individuals (n=49,734) and 0.74 (0.73 to 0.76), 0.84 (0.79 to 0.89), and 0.63 (0.61 to 0.65), respectively, among Black individuals (n=98,992). Mediation analyses showed that compared with non-Hispanic White individuals, lack of nephrology care explained 30% and 14% of incident home dialysis underuse among Hispanic and Black individuals, respectively (P < 0.001). Sensitivity analyses using a longer duration of nephrology care and KDE services and the sustained effect on home dialysis underuse through the first year after kidney failure showed congruent and consolidating findings. Conclusions Disparities in predialysis nephrology care were significantly associated with lower home dialysis use among Hispanic and Black individuals....

中文翻译：

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透析前肾脏病护理、肾脏疾病教育和家庭透析利用方面的种族和民族相关差异


需要 TUDIES 来揭示结构性种族主义影响边缘化人群家庭透析使用不足的层次。背景 透析前肾病学护理和 KRT 指导教育 （KDE） 对于事件家庭透析的使用至关重要。然而，晚期 CKD 患者的这些护理参数存在很大差异。这些差异对家庭透析使用不足的影响尚未得到检验。方法 我们分析了 2021 年美国肾脏数据库系统，以确定 2010 年至 2019 年间开始首次透析期间所有透析前 Medicare 承保超过 6 个月的成年肾功能衰竭患者。我们使用中介分析来剖析透析前肾病学护理和 KDE 差异对事件家庭透析使用的归因影响。此外，我们使用分级水平的介质和对家庭透析结局的持续影响进行了敏感性分析。结果我们确定了 464,310 名 Medicare 接受者： 428,301 名使用中心血液透析，35,416 名使用家庭透析作为研究期间的首次透析方式。与非西班牙裔白人患者 （n=294,914） 相比，接受透析前肾病护理、KDE 服务和新事件家庭透析的校正比值比（95% 置信区间）分别为 0.62（0.61 至 0.64）、0.58（0.52 至 0.63）和 0.76（0.73 至 0.79），西班牙裔个体 （n=49,734） 和 0.74（0.73 至 0.76）、0.84（0.79 至 0.89）和 0.63（0.61 至 0.65）， 分别在黑人个体中 （n=98,992）。中介分析显示，与非西班牙裔白人个体相比，缺乏肾脏病学护理分别解释了西班牙裔和黑人个体中 30% 和 14% 的家庭透析使用不足事件 （P < 0.001）。 使用较长时间的肾脏病学护理和 KDE 服务的敏感性分析以及肾衰竭后第一年对家庭透析使用不足的持续影响显示出一致和巩固的结果。结论 透析前肾病学护理的差异与西班牙裔和黑人个体较低的家庭透析使用率显著相关。