y small, educated audience. The survey included patients 18 or older, with 38% of respondents being black, 52% white, and 10% another ethnicity, with transplant recipients excluded.
“What we can learn from the results from this small sample of educated ESKD patients is there were no underlying race or ethnicity factors that would cause somebody to choose in-center over home dialysis. Rather, it’s more a construct of lack of education, as well as some socioeconomic factors that are barriers,” says Tonya Saffer, Outset Medical’s Head of Government Affairs and Market Access, who worked with NKF on the survey design.
Respondents older than 50 and with incomes of $75k or greater were found to be more likely to ease into dialysis, indicating that they were more aware of their kidney disease, while those younger than 50 and with incomes less than $75k were more likely to experience an unplanned or emergency start to treatment. More patients overall, however, are currently receiving in-center hemodialysis (67%) than at-home dialysis (42%), though respondents with higher annual household incomes are more likely to currently receive at-home dialysis than those with lower incomes. (See Box for additional survey findings regarding at-home dialysis.) Thus, socioeconomic factors, as supported by published literature, also appear to play a role in the disparities in awareness and utilization of treatment options such as home dialysis or kidney transplant.
RACIAL DISPARITIES IN DIALYSIS PATH TO TREATMENT SURVEY: PATIENT USE AND PERCEPTIONS OF HOME DIALYSIS
- Among those aware of home dialysis: patients are about equally likely to currently receive either home hemodialysis (HHD; 20%) or peritoneal dialysis (PD; 25%), although participants have more previous experience with PD (18%) than HHD (7%)
- There are no notable racial group differences on care team encouragement towards trying either HHD or PD
- Among those aware of but not currently receiving home dialysis, 41% have discussed the option with their care team in the last 6 months, 26% have most recently discussed it 1-2 years ago, and 10% have never discussed it
- Patients who are aware of HHD cite the lack of required travel (51%), the ability to complete treatment in their own home (51%), and flexibility in choosing a day/time for dialysis (47%) as advantages
Source: Hanover Research, on behalf of Outset Medical and the National Kidney Foundation
Based on the survey results, NKF and Outset are also working together to ensure more patients get connected to education to better manage their kidney disease earlier and on their options for a kidney transplant and home dialysis to make a difference in reducing disparities. The organizations have developed a treatment-focused educational curriculum for kidney disease patients, that will be piloted in June as part of a core curriculum offered by the successful National Kidney Foundation of Michigan (NKFM) community health outreach program.
Survey Results Emphasize Impact of Socioeconomic Status and Education
Importantly, results indicate that education provided outside the traditional healthcare setting, such as from external organizations like NKF, can play an important role in closing the racial gaps in home dialysis access and utilization. Patients of all backgrounds said that they refer to kidney disease-specific websites and/or health information websites before and after speaking to a medical professional, as well as patient information pamphlets. Overall, respondents indicated that their nephrologist provided education information on treatment options, along with renal dietitians, social workers, nephrology nurses, and other care team members (see the graphic below). Patients in all racial groups surveyed found the information provided by their care team to be useful, comprehensive, and proactively provided, although white respondents were more likely to do their own research following conversations with medical professionals.
Although a lower priority overall, white survey respondents were more likely than black respondents to pl