Among patients with autosomal dominant polycystic kidney disease, outcomes were strongly associated with race and ethnicity.

Further, investigators found Black and Hispanic patients with autosomal dominant polycystic kidney disease (ADPKD) experienced an earlier onset of kidney disease and less access to transplantation compared with white patients.

“Institutional racism affects the delivery of medical care, resulting in health disparities and poorer outcomes in Black and Hispanic patients,” Rita L. McGill, MD, MS, from the section of nephrology in the department of medicine at the University of Chicago, and colleagues wrote. They added, “The magnitude of health disparity varies throughout the U.S., where significant differences in care and outcomes in Black patients and Hispanic patients with kidney failure varies by geographic region. We therefore sought to evaluate medical care access and kidney outcomes in ADPKD patients in the U.S. based on self-reported racial and ethnic identity in the setting of socioeconomic and geographic factors.”

In a retrospective cohort analysis, researchers examined data for 41,485 adults with ADPKD (mean age was 56±12 years; 46% were women; 13% self-reported as Black; and 10% self-reported as Hispanic) in the U.S. Renal Data System from between January 2000 and June 2018. All data were merged with U.S. Census income data.

Researchers limited their analysis to “non-Hispanic white” patients, “non-Hispanic Black” patients and Hispanic patients. The median follow-up was 25 months.

Researchers used a linear model to determine age at onset of kidney failure after adjusting for confounders. Similarly, logistic and proportional hazards models determined transplant rates before and after dialysis initiation among Black patients and Hispanic patients compared with white patients with ADPKD.

Overall, Black patients, Hispanic patients and white patients were diagnosed with kidney failure at an average age of 55.3 years, 52.6 years and 56.9 years, respectively. Analyses revealed Black patients and Hispanic patients had 67% and 50% lower odds, respectively, of receiving a kidney transplant before dialysis initiation compared with white patients. Additionally, among those who initiated dialysis, Black patients and Hispanic patients were 39% and 22% less likely, respectively, to receive a kidney transplant compared with white patients.

“We discovered that progression to kidney failure occurred earlier in Black and Hispanic patients with ADPKD, and that access to transplantation was less than in white patients, both before and after the onset of dialysis treatment,” McGill said in the press release. “Our results suggest that there is potential to improve kidney care and kidney transplantation for Black and Hispanic patients.”

In an editorial, L. Ebony Boulware, MD, MPH, from the division of general internal medicine at Duke University, and colleagues suggested the patterns of racial and ethnic inequities noted in this study among those with ADPKD are “likely generalizable to other genetic conditions.”

Boulware and colleagues concluded, “Ultimately, racial and ethnic equity in kidney health will only be successfully achieved through sincere efforts that carefully take into account and comprehensively address the joint contributions of genetic, social, and environmental factors, as well as the receipt of equitable kidney care on the health of all individuals.”

References:

Addressing ‘second hits’ in the pursuit of greater equity in health outcomes for individuals with ADPKD. https://cjasn.asnjournals.org/content/early/2022/06/20/CJN.05970522. Published June 20, 2020. Accessed June 20, 2020.

Study reveals health disparities in autosomal dominant polycystic kidney disease in the United States. https://www.newswise.com/articles/study-reveals-health-disparities-in-autosomal-dominant-polycystic-kidney-disease-in-the-united-states/?ad2f=1&aid=772896. Published June 20, 2020. Accessed June 20, 2020.

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Race and Medicine