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

被引:66
作者
Frankenfield, DL
Rocco, MV
Frederick, PR
Pugh, J
McClellan, WM
Owen, WF
机构
[1] Hlth Care Financing Adm, Off Clin Standards & Qual, Baltimore, MD 21244 USA
[2] Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC 27109 USA
[3] S Texas Vet Hlth Care Syst, Vet Evidence Based Res Disseminat & Implementat C, San Antonio, TX USA
[4] Emory Univ, Sch Med, Program Hypertens & Renal Dis Hlth Serv Res, Atlanta, GA USA
[5] Emory Univ, Sch Med, Div Renal, Atlanta, GA USA
[6] Duke Univ, Med Ctr, Inst Renal Outcomes Res & Hlth Policy, Durham, NC USA
关键词
hemodialysis; demographics; race; Hispanic; ethnicity; Health Care Financing Administration;
D O I
10.1016/S0272-6386(99)70399-9
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Principal goals of the End-Stage Renal Disease (ESRD) Core Indicators Project are to improve the care provided to ESRD patients and to identify categorical variability in intermediate outcomes of dialysis care. The purpose of the current analysis is to extend our observations about the variability of intermediate outcomes of ESRD care among different racial and gender groups to a previously unreported group, Hispanic Americans. This group is a significant and growing minority segment of the ESRD population, A random sample of Medicare-eligible adult, in-center, hemodialysis patients was selected 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 or Hispanics (P < 0,001), Hispanics were more likely to have diabetes mellitus as a primary diagnosis than either blacks or whites (P < 0,001). Even though they received longer hemodialysis times and were treated with high-flux hemodialyzers, blacks had significantly lower hemodialysis doses than white or Hispanic patients (P < 0.001). The intradialytic weight losses were greater for blacks (P < 0,05), The delivered hemodialysis dose was lower for blacks than for whites or Hispanics whether measured as a urea reduction ratio (URR) or as the Kt/V calculated by the second generation formula of Daugirdas (median 1,32, 1,36, and 1.37, respectively, P < 0,001), Hispanics and whites had modestly higher hematocrits than blacks (33,2, 33,2, and 33.0%, respectively, P < 0.01), There was no significant difference among groups in the weekly prescribed epoetin alfa dose (similar to 172 units/kg/week), A significantly greater proportion of Hispanic patients had transferrin saturations greater than or equal to 20% compared with the other two groups (P < 0.001), Logistic regression modeling revealed that whites were significantly 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 URR < 65% (OR 1.5, P < 0.001 and 1,2, P < 0.05, respectively).
引用
收藏
页码:721 / 730
页数:10
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