Racial disparities in in-hospital outcomes and costs among U.S. patients on peritoneal dialysis: a 15-year national cohort study

Racial disparities in in-hospital treatment and outcomes among end-stage kidney disease (ESKD) patients receiving peritoneal dialysis (PD) are not well-characterized. This study aims to assess racial differences in treatment, complications, and resource utilization among hospitalized ESKD patients undergoing PD. This study was conducted using the National Inpatient Sample to identify hospitalization of ESKD patients receiving PD from the year 2003 to 2018. The racial difference in in-hospital treatment and outcomes was analyzed using logistic regression and in resource utilization using linear regression. White race was used as the reference group for outcome comparison. The analysis was adjusted for age, sex, year of hospitalization, Charlson comorbidity score, comorbidities, smoking, alcohol use, primary insurance, hospital type, size, and ownership. Among 82,704 hospitalizations of ESKD patients receiving PD, 44,552 (53.9%) were White, 23,608 (28.5%) were Black, 11,020 (13.3%) were Hispanic, and 3,524 (4.3%) were Asian and Pacific Islander. Black race was associated with higher odds for receiving PD catheter adjustment/removal, PD peritonitis, PD mechanical complications, volume overload but lower odds for receiving palliative care service, sepsis and in-hospital mortality, compared with White race. Hispanic race was associated with higher odds for receiving PD catheter adjustment/removal, blood transfusion, PD peritonitis, PD mechanical complications, volume overload, sepsis but lower odds for receiving palliative care service, metabolic acidosis, compared with White race. Asian/Pacific Islander race was associated with higher odds for receiving mechanical ventilation, blood transfusion, PD mechanical complications, sepsis but lower odds for hyperkalemia, compared with White race. Black race had lower, while Hispanic and Asian/Pacific Islander race had higher hospitalization cost, compared with White race. Hospitalizations of Black patients experienced more PD complications but lower mortality and costs, while hospitalizations of Hispanic and Asian/Pacific Islander patients faced higher complications and hospitalization costs. These findings underscore the need for equity-driven policies that promote culturally responsive, cost-effective, and complication-aware inpatient management strategies for PD patients.