Racia/ethnic analysis of selected intermediate outcomes for hemodialysis patients: Results from the 1997 ESRD Core Indicators Project

Principal goals of the End-Stage Renal Disease (ESRD) Core Indicators Proje ct are to improve the care provided to ESRD patients and to identify catego rical variability in intermediate outcomes of dialysis care. The purpose of the current analysis is to extend our observations about the variability o f intermediate outcomes of ESRD care among different racial and gender grou ps to a previously unreported group, Hispanic Americans. This group is a si gnificant and growing minority segment of the ESRD population, A random sam ple of Medicare-eligible adult, in-center, hemodialysis patients was select ed and stratified from an end-of-year ESRD patient census for 1996, Of the 6,858 patients in the final sample, 45% were non-Hispanic whites, 36% were non-Hispanic blacks, and 11% were Hispanic, Whites were older than blacks o r Hispanics (P < 0,001), Hispanics were more likely to have diabetes mellit us as a primary diagnosis than either blacks or whites (P < 0,001). Even th ough they received longer hemodialysis times and were treated with high-flu x hemodialyzers, blacks had significantly lower hemodialysis doses than whi te or Hispanic patients (P < 0.001). The intradialytic weight losses were g reater for blacks (P < 0,05), The delivered hemodialysis dose was lower for blacks than for whites or Hispanics whether measured as a urea reduction r atio (URR) or as the Kt/V calculated by the second generation formula of Da ugirdas (median 1,32, 1,36, and 1.37, respectively, P < 0,001), Hispanics a nd whites had modestly higher hematocrits than blacks (33,2, 33,2, and 33.0 %, respectively, P < 0.01), There was no significant difference among group s in the weekly prescribed epoetin alfa dose (similar to 172 units/kg/week) , A significantly greater proportion of Hispanic patients had transferrin s aturations greater than or equal to 20% compared with the other two groups (P < 0.001), Logistic regression modeling revealed that whites were signifi cantly more likely to have serum albumin < 3.5(BCG)/3.2(BCP) gm/dL (OR 1.4, p < 0.01); blacks were significantly more likely to have a delivered Kt/V < 1.2 (OR 1,4, P < 0.001) and hematocrit < 30%, (OR 1,2; P < 0.05) and both blacks and Hispanics were significantly more likely to have a delivered UR R < 65% (OR 1.5, P < 0.001 and 1,2, P < 0.05, respectively).