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In Predominately Black Communities, People Of All Races Miss Out On Kidney Care
Washington, DC — Regardless of race, fewer people see a kidney
specialist before starting dialysis if they live in predominantly black communities, reports a
study appearing in an upcoming issue of 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 October 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% of patients living in zip codes with <5% black residents
did not see a kidney specialist compared with 40.7% of those living in zip codes with >50%
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.
Dr. 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.
In reviewing the results of Dr. Prakash’s study in an accompanying editorial, Sharon Stein
Merkin, PhD (Geffen School of Medicine at UCLA) stated that the authors provide valuable
new information by focusing on the racial composition of regions rather than individual-level
factors. “Considering the important role of public health in implementing interventions at the
community level, this focus is crucial for pinpointing the needs and characteristics of
community-level interventions,” she wrote. Dr. Merkin added that the fact that the
investigators did not find an association between racial composition and quality of
nephrology care emphasizes the significance of focusing on access to nephrology care in
high-risk areas as a way to reduce morbidity and mortality related to ESRD.
Study co-authors include Rudolph Rodriguez, MD, Ann O’Hare, MD (VA Puget Sound
Healthcare System and University of Washington), Peter Austin, PhD (University of Toronto
and Institute for Clinical Evaluative Services), Refik Saskin (Institute for Clinical Evaluative
Sciences); Alicia Fernandez, MD (University of California, San Francisco); and Louise Moist,
MD, FRCPC (University of Western Ontario, in London, Canada).
Disclosures: Dr. Prakash received a travel grant to present this work at the World Congress
of Nephrology in Milan, Italy, 2009. Dr. Austin is supported by a Career Investigator Award
from the Heart and Stroke Foundation of Ontario. Dr. Fernandez is supported by a
K23RR18342 award from the National Institutes of Health/National Centre for Research
Resources. Dr. O’Hare is supported by a Beeson Career Development Award from the
National Institute of Aging (1K23AG28980). She also receives royalties from UpToDate and
an honorarium from the Japanese Society for Foot Care. Dr. Merkin, the author of the
editorial, reported no financial disclosures.
The article, entitled “Racial Composition of Residential Areas Associates with Access to Pre-
ESRD Nephrology Care” (doi 10.1681/ASN.2009101008) and accompanying editorial
entitled, “Neighborhoods, Race and Nephrology Care” (doi 10.1681/ASN.2010050534) will
appear online at http://jasn.asnjournals.org on June 17, 2010.
The content of this article does not reflect the views or opinions of The American Society of
Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely
with the author(s). ASN does not offer medical advice. All content in ASN publications is for
informational purposes only, and is not intended to cover all possible uses, directions,
precautions, drug interactions, or adverse effects. This content should not be used during a
medical emergency or for the diagnosis or treatment of any medical condition. Please consult
your doctor or other qualified health care provider if you have any questions about a medical
condition, or before taking any drug, changing your diet or commencing or discontinuing any
course of treatment. Do not ignore or delay obtaining professional medical advice because of
information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest
professional society devoted to the study of kidney disease. Comprised of 11,000 physicians
and scientists, ASN continues to promote expert patient care, to advance medical research,
and to educate the renal community. ASN also informs policymakers about issues of
importance to kidney doctors and their patients. ASN funds research, and through its worldrenowned
meetings and first-class publications, disseminates information and educational
tools that empower physicians.
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