Introduction: While Asian and Native Hawaiian and other Pacific Islander (NHOPI) patients have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asian and NHOPI individuals, we compared their ESKD outcomes based on residence in the mainland USA versus Hawaii/Pacific Islands (PIs). Materials and Methods: Using United States Renal Data System data, we examined the impact of geographic residence in the mainland versus Hawaii/PIs on race-mortality associations among incident ESKD patients transitioning to dialysis over January 1, 2000–December 31, 2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. Results: Compared with White patients in the mainland, Asian and NHOPI patients in the mainland had lower mortality: adjusted HRs (95% CIs) 0.67 (0.66–0.67) and 0.72 (0.70–0.73), respectively. When examining Asian and NHOPI patients in Hawaii/PIs, survival benefit was attenuated in Asian and diminished to the null in NHOPI patients (ref: mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asian and NHOPI patients in the mainland had the highest likelihood of transplantation, whereas NHOPI and Asian patients in Hawaii/PIs had the lowest likelihood. Conclusion: In the mainland, Asian and NHOPI patients had lower mortality versus White patients, whereas in Hawaii/PIs, this survival benefit was diminished in Asian and mitigated in NHOPI patients. NHOPI and Asian patients in Hawaii/PIs had less transplantation versus those in the mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asian and NHOPI patients across geographic residence.

Journal Section:
Novel Research Findings
Keywords:
Asian, Native Hawaiian, Pacific Islander, End-stage kidney disease
1.
Rhee CM, Chou JA, Kalantar-Zadeh K. Dialysis prescription and sudden death. Semin Nephrol. 2018;38(6):570–81.
https://doi.org/10.1016/j.semnephrol.2018.08.003
2.
Asian and pacific islander population in the United States. Available from: https://www.census.gov/library/visualizations/2020/demo/aian-population.html [Accessed December 30, 2020].
3.
Rhee CM. Serum potassium and the long interdialytic interval: minding the gap. Am J Kidney Dis. 2017;70(1):4–7.
https://doi.org/10.1053/j.ajkd.2017.04.007
4.
Rhee CM, Kalantar-Zadeh K. Implications of the long interdialytic gap: a problem of excess accumulation vs. excess removal?Kidney Int. 2015;88(3):442–4.
https://doi.org/10.1038/ki.2015.193
5.
Derose SF, Rutkowski MP, Crooks PW, Shi JM, Wang JQ, Kalantar-Zadeh K, et al. Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. Am J Kidney Dis. 2013;62(2):236–44.
https://doi.org/10.1053/j.ajkd.2013.01.019
6.
Hall YN, Hsu CY. New insights into the epidemiology of chronic kidney disease in US Asians and Pacific Islanders. Curr Opin Nephrol Hypertens. 2006;15(3):264–9.
https://doi.org/10.1097/01.mnh.0000222693.99711.4b
7.
Hall YN, Hsu CY, Iribarren C, Darbinian J, McCulloch CE, Go AS. The conundrum of increased burden of end-stage renal disease in Asians. Kidney Int. 2005;68(5):2310–6.
https://doi.org/10.1111/j.1523-1755.2005.00691.x
8.
Kataoka-Yahiro MR, Davis J, Rhee CM, Wong L, Hayashida G. Racial/ethnic differences in early detection and screening for chronic kidney disease among adults in Hawaii: a 10-year population health study. Prev Chronic Dis. 2020;17:E84.
https://doi.org/10.5888/pcd17.200011
9.
Wong LL, Kalantar-Zadeh K, Page V, Hayashida G, You AS, Rhee CM. Insights from screening a racially and ethnically diverse population for chronic kidney disease. Am J Nephrol. 2017;45(3):200–8.
https://doi.org/10.1159/000455389
10.
Rhee CM, Chen Y, You AS, Brunelli SM, Kovesdy CP, Budoff MJ, et al. Thyroid status, quality of life, and mental health in patients on hemodialysis. Clin J Am Soc Nephrol. 2017;12(8):1274–83.
https://doi.org/10.2215/CJN.13211216
11.
Kataoka-Yahiro MR, Wong KA, Tamashiro J, Page V, Ching J, Li D. Evaluation of the national kidney foundation of hawai“i”s kidney early detection screening program. Hawaii J Med Public Health. 2012;71(7):186–92.
12.
Mau MK, Sinclair K, Saito EP, Baumhofer KN, Kaholokula JK. Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders. Epidemiol Rev. 2009;31:113–29.
https://doi.org/10.1093/ajerev/mxp004
13.
Uchima O, Wu YY, Browne C, Braun KL. Disparities in diabetes prevalence among native hawaiians/other pacific Islanders and Asians in hawai’i. Prev Chronic Dis. 2019;16:E22.
https://doi.org/10.5888/pcd16.180187
14.
Zhao B, Jose PO, Pu J, Chung S, Ancheta IB, Fortmann SP, et al. Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern California 2010–2012. Am J Hypertens. 2015;28(5):631–9.
https://doi.org/10.1093/ajh/hpu189
15.
Picard K. Potassium additives and bioavailability: are we missing something in hyperkalemia management?J Ren Nutr. 2018;29(4):350-3.
16.
Artiga S, Foutz J, Cornachione E, Garfield R. The Henry J. Kaiser family foundation: key facts on health and health care by race and ethnicity. 2016 June. Available from: http://files.kff.org/attachment/Chartpack-Key-Facts-on-Health-and-Health-Care-by-Race-and-Ethnicity [Accessed 30 December 2020].
17.
Hawaii population characteristics 2019. Available from: https://census.hawaii.gov/wp-content/uploads/2020/06/Hawaii-Population-Characteristics-2019.pdf [Accessed 30 December 2020].
18.
Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc. 2013;88(9):987–95.
https://doi.org/10.1016/j.mayocp.2013.06.005
19.
Rodriguez RA, Hotchkiss JR, O’Hare AM. Geographic information systems and chronic kidney disease: racial disparities, rural residence and forecasting. J Nephrol. 2013;26(1):3–15.
https://doi.org/10.5301/jn.5000225
20.
Hall YN, Sugihara JG, Go AS, Chertow GM. Differential mortality and transplantation rates among Asians and Pacific Islanders with ESRD. J Am Soc Nephrol. 2005;16(12):3711–20.
https://doi.org/10.1681/ASN.2005060580
21.
The asian population 2010. Available from: https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf [Accessed 30 December 2020].
22.
Kistler BM, Benner D, Burrowes JD, Campbell KL, Fouque D, Garibotto G, et al. Eating during hemodialysis treatment: a consensus statement from the international society of renal nutrition and metabolism. J Ren Nutr. 2018;28(1):4–12.
https://doi.org/10.1053/j.jrn.2017.10.003
23.
United States Renal Data System. Researcher’s guide to the USRDS database appendix A: USRDS products and services. 2019. Available from: https://www.usrds.org/media/2451/researchers_guide_appendix_a_19.pdf [Accessed 1 January 2021].
24.
Saglimbene VM, Wong G, Ruospo M, Palmer SC, Garcia-Larsen V, Natale P, et al. Fruit and vegetable intake and mortality in adults undergoing maintenance hemodialysis. Clin J Am Soc Nephrol. 2019;14(2):250–60.
https://doi.org/10.2215/CJN.08580718
25.
Yan G, Shen JI, Harford R, Yu W, Nee R, Clark MJ, et al. Racial and ethnic variations in mortality rates for patients undergoing maintenance dialysis treated in US territories compared with the US 50 states. Clin J Am Soc Nephrol. 2020;15(1):101–8.
https://doi.org/10.2215/CJN.03920319
26.
Mau MK, West M, Sugihara J, Kamaka M, Mikami J, Cheng SF. Renal disease disparities in Asian and Pacific-based populations in Hawai’i. J Natl Med Assoc. 2003;95(10):955–63.
27.
Tsukamoto Y. End-stage renal disease (ESRD) and its treatment in Japan. Nephrol Dial Transpl. 2008;23(8):2447–50.
https://doi.org/10.1093/ndt/gfn232
28.
Rhee CM, Lertdumrongluk P, Streja E, Park J, Moradi H, Lau WL, et al. Impact of age, race and ethnicity on dialysis patient survival and kidney transplantation disparities. Am J Nephrol. 2014;39(3):183–94.
https://doi.org/10.1159/000358497
29.
Narayan KM, Aviles-Santa L, Oza-Frank R, Pandey M, Curb JD, McNeely M, et al. Report of a national heart, lung, and blood Institute workshop: heterogeneity in cardiometabolic risk in asian Americans in the U.S. Opportunities for research. J Am Coll Cardiol. 2010;55(10):966–73.
https://doi.org/10.1016/j.jacc.2009.07.075
© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.