Kidney disease: Is dialysis the best treatment for different ethnicities?

• More than 10% of people worldwide have kidney disease.
• Although 78% of people with advanced kidney disease opt for dialysis, that is not always a viable treatment option.
• Researchers from the University of California Irvine show certain ethnic groups have higher hospitalization rates when treated with dialysis rather than conservative management.

Kidney disease affects more than 10% of the global population, totaling more than 800 million people.

If a person’s kidney disease progresses to where one or both kidneys start to fail, treatment options may include a kidney transplant or dialysis where a machine is used to carry out the waste-removing functions of the kidneys.

Another treatment option for people with advanced kidney disease is conservative management. This treatment does not provide dialysis. Instead, it focuses on treating a person’s symptoms and quality of life.

A research team from the University of California Irvine recently presented a study at the American Society of Nephrology annual conference Kidney Week 2022 showing that certain ethnic groups may have better hospitalization outcomes with a conservative management treatment rather than dialysis.

Conservative management vs. dialysis

When a person has kidney disease, their kidneys are no longer able to properly remove waste and excess fluids from the body, turning them into urine.

There are five stages to kidney disease. A person reaches stage 5 when one or both of their kidneys fail or are close to failing due to damage to the kidneys. When this occurs, a person needs to make lifestyle changes to properly remove waste from the body.

One of these lifestyle change options is dialysis. About 78% of people worldwide with kidney disease have dialysis as a treatment option.

Through dialysis, a machine takes the place of a person’s kidneys pumping blood out of a person’s body, cleaning it of waste, and pumping the filtered blood back into the body. Dialysis occurs either at a hospital, dialysis center, or at home.

Side effects of dialysis

Some people may experience side effects with dialysis, including:

• muscle cramps
• sleeping issues
• depression
• low blood pressure
• itchy skin
• infection at the body’s dialysis access site

Although dialysis is a popular treatment option for advanced kidney disease, it is not appropriate for everyone. For example, people on dialysis are at an increased risk for heart failure. Previous research shows there may be an increased risk of dementia in people who receive dialysis.

And research shows dialysis can have a negative impact on a person’s quality of life.

For these reasons, sometimes people with advanced kidney disease will opt for a non-dialysis treatment called conservative management. This option focuses on treatings the symptoms of kidney disease through lifestyle and diet changes, medications, and support services.

Previous research shows conservative management to be a viable treatment option for older people with kidney disease. Additionally, studies show people receiving conservative management can possibly live for years with proper support.

However, research shows there are many misconceptions about conservative management, and doctors do not always provide it as an alternative to people with kidney disease.

Does ethnicity affect kidney disease treatment? 

For this study, researchers compared hospitalization records for over 309,000 people with advanced kidney disease treated with either dialysis or conservative management for a period of 13 years. Within this group, 55% were hospitalized at least once.

Upon analysis, researchers found that non-Hispanic white, non-Hispanic Black, and Hispanic people who received dialysis had higher hospitalization rates than those who underwent conservative management.

Of those ethnic groups, people who started dialysis early when their kidneys still had a relatively high functioning level had the highest hospitalization rate, compared to people who started dialysis when their kidneys were at a low functioning level.

Researchers also found people of Asian descent in the study population group had a higher hospitalization rate if they received dialysis.

However, in this ethnic group people who started dialysis late had higher hospitalization rates than those on early dialysis, particularly in older age groups.

Of those reporting hospitalizations, the most common reasons were for:

• congestive heart failure/ fluid overload
• respiratory problems
• hypertension

“There has been growing recognition of the importance of conservative non-dialytic management as an alternative patient-centered treatment strategy for advanced kidney disease,” explains Dr. Connie Rhee, associate professor of medicine, associate professor of public health, and vice chair of clinical research in the Department of Medicine at the University of California, Irvine, and member of the research team.

“[C]onservative management remains under-utilized in the U.S., which may in part be due to uncertainties regarding which patients will most benefit from dialysis vs. non-dialytic treatment.”
— Dr. Connie Rhee

“We hope that these findings and further research can help inform treatment options for patients, care partners, and providers in the shared decision-making process of conservative management vs. dialysis,” adds Dr. Rhee.

Encouragement for dialysis alternatives

Medical News Today spoke with Jennifer Prescott, registered nurse and owner of Blue Water Homecare and Hospice, about these findings. She said the study findings may encourage physicians to investigate alternatives to dialysis with people with advanced chronic kidney disease.

“Other studies have supported the use of conservative care instead of dialysis resulting in [fewer] inpatient hospital stays, had [fewer] physician visits, and less overall cost to the healthcare delivery system,” Prescott continued.

“In my experience, the impact of dialysis on the person and family can be significant including caregiver burden, decreased quality of life, and less utilization of palliative/hospice care,” she added.

According to Prescott, the most common misconception is that the only alternative to dialysis is no care or death.

“I believe we will see more research on alternatives to dialysis for conservative treatment of advanced kidney disease,” she said.

“Research looking at the quality of life, mortality, and relationships between race/ethnicity and age may encourage physicians and patients to choose alternatives to dialysis. This may help physicians to develop models of care that focus on improving outcomes and quality of life for people with chronic kidney disease.”
— Jennifer Prescott, registered nurse

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