{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:52:44Z","timestamp":1791183164633,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Racial and ethnic disparities in access to home\u2010based renal replacement therapies (RRT) remain a major concern in the management of end\u2010stage renal disease (ESRD) in the United States. Despite national efforts to expand home hemodialysis (HHD) and peritoneal dialysis (PD), inequities at treatment initiation persist. Therefore, the goal was to evaluate racial and ethnic disparities in the initial modality of RRT among incident adult ESRD patients in the United Stated from 2014 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, pooled cross\u2010sectional study used United States Renal Data System (USRDS) data on adults initiating dialysis between 2014 and 2020. Descriptive analyses compared biological, environmental, and behavioral determinants across modalities. Poisson regression models with robust variance estimated adjusted incidence rate ratios (IRRs) for initiating HHD or PD versus in\u2010center hemodialysis (ICHD), controlling for demographic, clinical, socioeconomic, and behavioral factors within an integrated health risk management framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3.49 million incident ESRD cases, 82.8% initiated ICHD, 15.5% PD, and 1.7% HHD. Significant disparities were observed by race\/ethnicity. Compared with White patients, Black patients had markedly lower adjusted incidence rates of initiating HHD (IRR 0.69; 95% CI 0.67\u20130.72) and PD (IRR 0.55; 95% CI 0.55\u20130.56). Hispanic or Latino patients similarly demonstrated reduced initiation of HHD (IRR 0.42; 95% CI 0.40\u20130.45) and PD (IRR 0.64; 95% CI 0.64\u20130.65). Asian patients had a modestly higher adjusted rate of PD initiation (IRR 1.08; 95% CI 1.06\u20131.09) but lower rates of HHD. Other racial groups also showed consistently reduced use of home modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Substantial racial and ethnic disparities persist in the initiation of home dialysis in the U.S. While structural and system\u2010level factors likely contribute, patient\u2010level clinical considerations, cultural norms, social support availability, and provider practice patterns also play important roles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sdi.70050","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:33:53Z","timestamp":1791182033000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Racial and Ethnic Disparities in Access to Home\u2010Based Renal Replacement Therapies Among Incident End\u2010Stage Renal Disease Patients in the United States"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9873-1570","authenticated-orcid":false,"given":"Andres Mauricio","family":"Garcia\u2010Sierra","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences University of Chicago  Chicago Illinois USA"},{"name":"School of Global Health and Informatics University of Central Florida  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Ram\u00edrez","sequence":"additional","affiliation":[{"name":"School of Global Health and Informatics University of Central Florida  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Chronic Kidney Disease in the United States, 2023 [Internet]","author":"Centers for Disease Control and Prevention","year":"2023"},{"key":"e_1_2_10_3_1","volume-title":"USRDS Annual Data Report: Epidemiology of kidney disease in the United States [Internet]","author":"United States Renal Data System","year":"2023"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2019.11.006"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.11.015"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102369\u201015\u2010192"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnw267"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/10807030701655798"},{"key":"e_1_2_10_9_1","volume-title":"Advancing American Kidney Health [Internet]","author":"U.S. Department of Health and Human Services","year":"2019"},{"key":"e_1_2_10_10_1","volume-title":"National Health Statistics Reports [Internet]","author":"Stierman B.","year":"2021"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/08968608241234525"},{"issue":"10","key":"e_1_2_10_12_1","first-page":"S163","article-title":"All\u2010Cause Costs Increase Exponentially With Increased Chronic Kidney Disease Stage","volume":"23","author":"Golestaneh L.","year":"2017","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S81284"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.2196\/17194"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010025\u201004104\u20104"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2024.06.015"},{"issue":"4","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.37526\/1526-744X.2025.52.4.411","article-title":"Shared Decision\u2010Making and Quality of Life in Patients With Chronic Kidney Disease: A Systematic Review","volume":"52","author":"Kim M. 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