TORONTO—Regardless of race, fewer people see a kidney specialist before starting dialysis if they live in predominantly black communities, according to a study appearing online June 17 in the Journal of the American Society Nephrology (JASN).
The results highlight the importance of understanding why patients in predominantly black areas are less likely to receive kidney-related care while their kidney function is clearly declining.
Black patients with kidney disease are disproportionately more likely to progress to kidney failure compared with other races. Also, a large proportion of black patients starting dialysis live in predominantly black residential areas. Suma Prakash, MD, FRCPC (University of Toronto, in Canada) and her colleagues investigated whether patient location has an effect on access to and quality of kidney-related care before starting dialysis, independent of individual patients’ race.
The researchers retrospectively studied 92,000 white and black adults who started dialysis in the United States between June 1, 2005 and Oct. 5, 2006. They found that a residential area’s racial composition had a significant effect on a patient’s access to a kidney specialist before starting dialysis, regardless of the patient’s race.
Specifically, as the percentage of blacks in residential areas increased, the likelihood of not receiving pre-dialysis kidney care from a specialist increased: 29.5 percent of patients living in zip codes with less than 5 percent black residents did not see a kidney specialist compared with 40.7 percent of those living in zip codes with more than 50 percent black residents. However, if a patient received care from a specialist before starting dialysis, the quality of this care was no different in predominantly black areas compared with other residential areas.
Prakash noted that the findings might be explained by several factors, such as the availability of pre-dialysis patient education or the accessibility of primary care doctors and kidney specialists. Addressing these findings might lead to improved access to kidney care in predominantly black residential areas.
