Differences in Outcomes by Place of Origin among Hispanic Patients with Kidney Failure

Abstract

Background Compared with non-Hispanic White groups, Hispanic individuals have a higher risk of kidney failure yet lower rates of living donor transplantation and home dialysis. However, how home dialysis, mortality, and transplantation vary within the Hispanic community depending on patients’ place of origin is unclear. Methods We identified adult Hispanic patients from the US Renal Data System who initiated dialysis in 2009 to 2017. Primary exposure was country or territory of origin (US, Mexico, US–Puerto Rico, and other countries). We used logistic regression to estimate differences in odds of initiating home dialysis and competing risk models to estimate subdistribution hazard ratios (SHR) of mortality and kidney transplantation. Results Of 137,039 patients, 44.4% were US-born, 30.9% were from Mexico, 12.9% were from US–Puerto Rico, and 11.8% were from other Latin American countries. Home dialysis rates were lower than among US-born patients but not significantly different after adjusting for demographic, medical, socioeconomic, and facility-level factors. Adjusted mortality risk was higher for individuals from US–Puerto Rico (SHR, 1.04; 95% confidence interval [CI], 1.01 to 1.08) and lower for Mexico (SHR, 0.80; 95%CI, 0.78 to 0.81) and other countries (SHR, 0.83; 95% CI, 0.81 to 0.86) compared with US-born patients. The adjusted rate of transplantation for Mexican or US–Puerto Rican patients was similar to that of US-born patients but higher for those from other countries (SHR, 1.22; 95% CI, 1.15 to 1.30). Conclusions Hispanic people from different places of origin have similar adjusted rates of home dialysis but different adjusted rates of mortality and kidney transplantation. Further research is needed to understand the mechanisms underlying these observed differences in outcomes.