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Racial differences in clinical use of cinacalcet in a large population of hemodialysis patients.
- Source :
-
American journal of nephrology [Am J Nephrol] 2013; Vol. 38 (2), pp. 104-14. Date of Electronic Publication: 2013 Jul 30. - Publication Year :
- 2013
-
Abstract
- Background/aims: African-Americans with end-stage renal disease receiving dialysis have more severe secondary hyperparathyroidism than Whites. We aimed to assess racial differences in clinical use of cinacalcet.<br />Methods: This retrospective cohort study used data from DaVita, Inc., for 45,589 prevalent hemodialysis patients, August 2004, linked to Centers for Medicare & Medicaid Services data, with follow-up through July 2007. Patients with Medicare as primary payer, intravenous vitamin D use, or weighted mean parathyroid hormone (PTH) level >150 pg/ml at baseline (August 1-October 31, 2004) were included. Cox proportional hazard modeling was used to evaluate race and other demographic and clinical characteristics as predictors of cinacalcet initiation, titration, and discontinuation.<br />Results: Of 16,897 included patients, 7,674 (45.4%) were African-American and 9,223 (54.6%) were white; 53.2% of cinacalcet users were African-American. Cinacalcet was prescribed for 47.7% of African-Americans and 34.5% of Whites, and for a greater percentage of African-Americans at higher doses at each PTH strata. After covariate adjustment, African-Americans were more likely than Whites to receive cinacalcet prescriptions (hazard ratio 1.17, p < 0.001). The direction and magnitude of this effect appeared to vary by age, baseline PTH, and calcium, and by elemental calcium use. African-Americans were less likely than Whites to have prescriptions discontinued and slightly more likely to undergo uptitration (hazard ratio 1.09, 95% confidence interval 0.995-1.188), but this relationship lacked statistical significance.<br />Conclusion: Cinacalcet is prescribed more commonly and at higher initial doses for African-Americans than for Whites to manage secondary hyperparathyroidism.
- Subjects :
- Adolescent
Adult
Aged
Centers for Medicare and Medicaid Services, U.S.
Cinacalcet
Female
Humans
Kidney Failure, Chronic drug therapy
Male
Middle Aged
Parathyroid Hormone therapeutic use
Proportional Hazards Models
Quality of Health Care
Retrospective Studies
Time Factors
Treatment Outcome
United States
Vitamin D therapeutic use
White People
Young Adult
Black or African American
Calcimimetic Agents therapeutic use
Healthcare Disparities
Kidney Failure, Chronic ethnology
Kidney Failure, Chronic therapy
Naphthalenes therapeutic use
Renal Dialysis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9670
- Volume :
- 38
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- American journal of nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 23899621
- Full Text :
- https://doi.org/10.1159/000353298