Impact of poverty and race on pre-end-stage renal disease care among dialysis patients in the United States

Robert Nee*, Christina M. Yuan, Frank P. Hurst, Rahul M. Jindal, Lawrence Y. Agodoa, Kevin C. Abbott

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: Access to nephrology care prior to end-stage renal disease (ESRD) is significantly associated with lower rates of morbidity and mortality.We assessed the association of area-level and individual-level indicators of poverty and race/ethnicity on pre-ESRD care provided by nephrologists. Methods: In this retrospective cohort study using the US Renal Data System database,we identified 739 537 patients initiated on maintenance dialysis from1 January 2007 through 31 December 2012.We assessed the Medicare-Medicaid dual eligibility status as an indicator of individual-level poverty and ZIP code-level median household income (MHI) data obtained from the 2010 US census. We conducted multivariable logistic regression of pre-ESRD nephrology care as the outcome variable. Results: Among patients in the lowest area-level MHI quintile, 61.28% received pre-ESRD nephrology care versus 67.68% among those in higher quintiles (P < 0.001). Similarly, the proportions of dual-eligible and nondual-eligible patients who had pre-ESRD nephrology care were 61.49 and 69.84%, respectively (P < 0.001). Patients in the lowest area-level MHI quintile were associated with significantly lower likelihood of pre-ESRD nephrology care (adjusted odds ratio [aOR] 0.86 [95% confidence interval (CI) 0.85- 0.87]) compared with those in higher quintiles. Both African American (AA) and Hispanic patients were significantly less likely to have received pre-ESRD nephrology care [aOR 0.85 (95% CI 0.84-0.86) and aOR 0.72 (95% CI 0.71-0.74), respectively]. Conclusions: Individual- and area-level measures of poverty, AA race and Hispanic ethnicity were independently associated with a lower likelihood of pre-ESRD nephrology care. Efforts to improve pre-ESRD nephrology care may require focusing on the poor and minority groups.

Original languageEnglish
Pages (from-to)55-61
Number of pages7
JournalClinical Kidney Journal
Issue number1
StatePublished - 1 Feb 2017
Externally publishedYes


  • End-stage renal disease
  • Poverty
  • Pre-ESRD care
  • Racial disparities


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