Ethnic differences in the use of peritoneal dialysis as initial treatment for end-stage renal disease.

Abstract

OBJECTIVE: To evaluate the influence of ethnicity on the use of peritoneal dialysis (PD) as initial treatment for end-stage renal disease (ESRD) after controlling for other patient characteristics. DESIGN: Inception cohort analysis of incident ESRD patients. PATIENTS: All African-American and white patients (N = 10,726) who began treatment for ESRD at dialysis centers in North Carolina, South Carolina, and Georgia and reported to ESRD Network 6 between January 1, 1989, and December 31, 1991. MAIN OUTCOME MEASURE: Odds ratios (ORs) of the association between ethnicity and PD as initial treatment modality. RESULTS: African-American patients were 56% less likely than whites to use PD (OR, 0.44; 95% confidence interval [CI], 0.40 to 0.49). This difference persisted (OR, 0.45; 95% CI, 0.38 to 0.52) after multivariable adjustment for age, education, social support, home ownership, functional status, albumin level, hypertension, history of myocardial infarction, peripheral neuropathy, and comorbid diabetes. CONCLUSIONS: Ethnic differences in initial PD use cannot be explained by many demographic, socioeconomic, and comorbid factors associated with the use of PD as initial treatment for ESRD.