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Racial and Ethnic Disparities in Home Dialysis Use in the United States: Barriers and Solutions.

In 2019, the Advancing American Kidney Health (AAKH) Executive Order set a goal: by 2025, 80% of patients with incident kidney failure should be started on home dialysis therapies, or receive a kidney transplant. Racial and ethnic minority populations have a disproportionately high risk of kidney failure: Black and Latinx individuals have a 3.4-fold and 1.3-fold greater risk, respectively, compared with non-Latinx White people. Despite this, Black and Latinx patients are less likely than non-Latinx White patients to be treated with home dialysis: 7.3% of Black patients and 7.4% of Latinx prevalent patients with kidney failure are treated with home dialysis therapies, compared with 9.3% of non-Latinx White patients. The lower rates of home dialysis use in the Black and Latinx communities are not completely explained by geographic, demographic, and clinical factors. This perspective examines other contributing factors, specifically environmental, social, and systemlevel barriers to home dialysis faced by Black and Latinx patients with kidney failure. It also offers solutions to the problem of inequitable access to home modalities.