Rekabdarkolaee Hossein Moradi, Longacre Lauren E, Isaacson Mary J, Varilek Brandon M
Department of Mathematics & Statistics, South Dakota State University, Brookings, SD, USA.
College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Hosp Palliat Care. 2025 Jan 20:10499091251315419. doi: 10.1177/10499091251315419.
American Indian/Alaska Native (AI/AN) persons disproportionately suffer from end-stage kidney disease caused by diabetes (ESKD-D). Kidney transplant is the most desirable option to treating ESKD-D, but remains unattainable for many AI/AN persons, especially in rural South Dakota (SD). Additionally, palliative and hospice care options for AI/AN with any serious illness in SD are largely inaccessible. Moreover, receiving kidney transplant potentially affects hospice referral because of the desire to prolong transplant function. Therefore, the purpose of this study was to compare hospice use rates among AI/AN and non-Hispanic White (NHW) persons with ESKD-D prior to death and determine if differences in referral rates are present for those with and without a prior kidney transplant.
Retrospective cohort analysis of United States Renal Data System data from 2000-2021. Data for persons with hospice care, transplant status, place of death, and race were analyzed using chi-squared tests with Yates' continuity correction and the Cochran-Mantel-Haenszel test.
AI/AN persons with ESKD-D were less likely to receive hospice care prior to death compared to NHW persons in both transplant ( < 0.001) and non-transplant ( < 0.001) groups. When comparing transplant and non-transplant groups by hospice use, persons with no previous transplant were more likely to receive hospice care prior to death ( < 0.001).
These results confirm the assumptions of significant differences in hospice care use among AI/AN vs NHW who have ESKD-D, including differences between those with a prior transplant. There is a need to expand palliative/hospice care services for persons with a prior kidney transplant.
美国印第安人/阿拉斯加原住民（AI/AN）人群患糖尿病所致终末期肾病（ESKD-D）的比例过高。肾移植是治疗ESKD-D最理想的选择，但对许多AI/AN人群来说仍然无法实现，尤其是在南达科他州（SD）农村地区。此外，SD地区患有任何严重疾病的AI/AN人群基本无法获得姑息治疗和临终关怀服务。此外，由于希望延长移植肾功能，接受肾移植可能会影响临终关怀转诊。因此，本研究的目的是比较AI/AN和非西班牙裔白人（NHW）ESKD-D患者在死亡前的临终关怀使用率，并确定既往有或无肾移植患者的转诊率是否存在差异。
对2000 - 2021年美国肾脏数据系统的数据进行回顾性队列分析。使用带有Yates连续性校正的卡方检验和Cochran-Mantel-Haenszel检验分析接受临终关怀、移植状态、死亡地点和种族的数据。
在移植组（<0.001）和非移植组（<0.001）中，与NHW患者相比，患有ESKD-D的AI/AN患者在死亡前接受临终关怀的可能性较小。按临终关怀使用情况比较移植组和非移植组时，既往未接受移植的患者在死亡前更有可能接受临终关怀（<0.001）。
这些结果证实了以下假设，即患有ESKD-D的AI/AN与NHW在临终关怀使用方面存在显著差异，包括既往有移植史的患者之间的差异。有必要为既往有肾移植史的患者扩大姑息/临终关怀服务。
