Sex and Racial/Ethnic Differences in Home Hemodialysis Mortality

Background: Women and minorities constitute substantial portions of the prevalent population of kidney failure patients. Little is known about sex and racial/ethnic differences in mortality among patients with kidney failure on home hemodialysis in the United States. Methods: Using the United States Renal Data System, we retrospectively evaluated a cohort of 42,849 patients who started home hemodialysis between January 1, 2005, and December 31, 2015. We examined the association of sex and race/ethnicity with the outcome of all-cause mortality using adjusted Cox proportional hazard models and logistic regression models. Results: In the study cohort, 40.4% were women, and 57.4% were White. Women on home hemodialysis had higher unadjusted death rates (26.9 vs. 22.4 per 100 person-years) as compared to men. There was no difference in adjusted all-cause mortality between men and women, but women had an 8% higher adjusted risk of all-cause mortality at one-year after initiating home hemodialysis (OR 1.08, 1.01-1.15). With regards to race/ethnicity, Hispanic, White, and Blacks had higher unadjusted death rates as compared to Asians and Native Americans (25.1 vs. 24.8 vs. 23.2 vs. 17.4 vs.16.6 per 100 person-years). There was no difference in adjusted all-cause mortality in Black, Hispanic, and Native Americans as compared to Whites, while Asians had a lower risk of all-cause mortality than did Whites (HR, 0.81; CI, 0.72-0.92). There was no difference in adjusted one-year mortality for Asian, Black, Hispanic, and Native American patients, as compared to White patients. Conclusion: Among patients undergoing home hemodialysis, women have higher one-year mortality than men, and women and men have comparable survival on long-term follow-up after adjusting for other covariates. Compared to Whites, there was no difference in adjusted survival on long-term follow-up for Blacks, Hispanics, or Native Americans, while Asians had better survival. Our results suggest the need for population-wide strategies to overcome differences in home hemodialysis care.