Background End-of-life care is a prominent consideration in patients on maintenance dialysis, especially when death appears imminent and quality of life is poor. To date, examination of race- and ethnicity-associated disparities in end-of-life care for patients with ESRD has largely been restricted to comparisons of white and black patients.

Methods We performed a retrospective national study using United States Renal Data System files to determine whether end-of-life care in United States patients on dialysis is subject to racial or ethnic disparity. The primary outcome was a composite of discontinuation of dialysis and death in a nonhospital or hospice setting.

Results Among 1,098,384 patients on dialysis dying between 2000 and 2014, the primary outcome was less likely in patients from any minority group compared with the non-Hispanic white population (10.9% versus 22.6%, P<0.001, respectively). We also observed similar significant disparities between any minority group and non-Hispanic whites for dialysis discontinuation (16.7% versus 31.2%), as well as hospice (10.3% versus 18.1%) and nonhospital death (34.4% versus 46.4%). After extensive covariate adjustment, the primary outcome was less likely in the combined minority group than in the non-Hispanic white population (adjusted odds ratio, 0.55; 95% confidence interval, 0.55 to 0.56; P<0.001). Individual minority groups (non-Hispanic Asian, non-Hispanic black, non-Hispanic Native American, and Hispanic) were significantly less likely than non-Hispanic whites to experience the primary outcome. This disparity was especially pronounced for non-Hispanic Native American and Hispanic subgroups.

Conclusions There appear to be substantial race- and ethnicity-based disparities in end-of-life care practices for United States patients receiving dialysis.

背景技术终止透析是维持性透析患者的重要考虑因素，尤其是当死亡即将来临且生活质量较差时。迄今为止，对ESRD患者临终关怀中种族和种族相关的差异的检查在很大程度上仅限于白人和黑人患者的比较。

方法我们使用美国肾脏数据系统文件进行了一项回顾性全国研究，以确定接受透析的美国患者的临终护理是否存在种族或族裔差异。主要结局是在非医院或临终关怀医院中终止透析和死亡的复合结果。

结果在2000年至2014年之间透析死亡的1,098,384名患者中，与非西班牙裔白人相比，任何少数族裔患者的主要结局可能性均较小（分别为10.9％和22.6％，P <0.001）。我们还观察到任何少数族裔群体与非西班牙裔白人之间的透析中断（16.7％对31.2％），临终关怀（10.3％对18.1％）和非医院死亡（34.4％对46.4％）之间存在相似的显着差异。经过广泛的协变量调整后，合并的少数群体的主要结局发生率比非西班牙裔白人人口少（调整后的优势比为0.55； 95％的置信区间为0.55至0.56；P<0.001）。少数群体（非西班牙裔亚裔，非西班牙裔黑人，非西班牙裔美国原住民和西班牙裔）经历主要结局的可能性明显低于非西班牙裔白人。对于非拉美裔美洲原住民和拉美裔亚族群来说，这种差异尤为明显。

结论对于接受透析的美国患者，在临终护理实践中似乎存在基于种族和族裔的巨大差异。